We describe this case of a middle aged homosexual malepatient with severe internal hemorrhoids. This patient waspresented at our department for a Longo stapled hemor-rhoidopexy. Generally the Longo procedure is chosen in ourdepartment above the open Milligan-Morgan hemorrhoidec-tomy due to faster recovery, less residual pain after theprocedure and proven to provide similar results on long term.1Unfortunately, there are little data available of the fate of thestaples in the anal canal. It is supposed that most of the sta-ples are covered by mucosa or fade out after a few months.During this healing process, anal intercourse is discouragedas penile injury or condom rupture are described.2The lengthof the healing process is estimated on a few months in liter-ature. As Kekez3already reported these staples line remainvisible on X-rays and anoscopy 12 months after the proce-dure and therefore suggested a permanent risk for condomand penile injury. Beside the possible physical injury of thegenitals, the potential transfer of Sexually Transmitted Dis-eases (STD) cannot be ignored. Another potential problem isthe limited diameter of the stapler. As general surgeons, weoccasionally notice larger diameters of the rectum and analcanal due to repetitive insertion of objects. These dilated analcanals can be treated with the Longo technique but the resid-ual scarred ring could be injured in future insertions of objectswith the possibility of rectal and anal rupture. These risks werediscussed with the patient and there was chosen for a conser-vative non-surgical treatment. We assume not all physicianfeel comfortable asking their patients about their sexual pref-erence in the informed consent, and therefore this possiblecomplication and future sexual limitation is ignored. This sub-ject is not only taboo in the consultation room, but also inliterature.
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