Off-label use of novel hemostatic gel to treat wound dehiscence after stapled hemorrhoidectomy

A 54-year-old man complaining of massive rectal bleeding and severe anemia was referred to our endoscopic center by the surgical unit. He had undergone stapled hemorrhoidectomy with Longo’s technique 3 weeks before, and had received topical steroid and mesalamine therapy for 1 week without clinical improvement.

Rectosigmoidoscopy was scheduled and performed, showing a 3-cm dehiscence caused by impaired or delayed wound healing at the dentate line ([Fig. 1]). During the same procedure, 3 ml of the novel hemostatic gel Purastat was applied to obtain formation of a synthetic clot covering the entire dehiscence area. No bleeding or other complications were observed during or after the procedure ([Fig. 2]).

Fig. 1 Rectosigmoidoscopic view of 3-cm posthemorroidectomy wound dehiscence at the dentate line.

Fig. 2 Endoscopic application of the novel hemostatic gel.

Four weeks later, the patient underwent scheduled follow-up rectosigmoidoscopy, which showed scarring of the area with complete mucosal healing ([Fig. 3]). No bleeding, tenesmus, or other symptoms were reported by the patient ([Video 1]).

Fig. 3 Efficacy of the hemostatic gel in wound healing. The wound is shown a before the procedure and b 4 weeks after application of the hemostatic gel.

Video 1 Endoscopic application of a novel hemostatic gel to treat wound dehiscence after stapled hemorrhoidectomy.

Wound dehiscence is an early complication of stapled hemorrhoidectomy, with a prevalence of 3 %–5 %; it has been attributed to malfunctioning staplers and surgical inexperience, and surgical revision is often required [1]. Purastat is an uncolored, fully synthetic, viscous peptide hydrogel that self-assembles into fibers forming a sort of extracellular matrix; this matrix then acts as a mechanical barrier on the bleeding source, providing a hemostatic effect [2]. In addition to the known hemostatic effect, it has been hypothesized that the similarity of the 3 D nanostructure of activated Purastat to the natural extracellular matrix scaffold material favors cell and tissue proliferative processes, leading to more effective mucosal healing [3].

This treatment may become a valid alternative to revision surgery in patients with wound dehiscence following stapled hemorrhoidectomy.

Endoscopy_UCTN_Code_CCL_1AD_2AJ

Conflict of interest

The authors declare that they have no conflict of interest.

• References

• 1 Nally C, Singer M. Reoperative surgery for complications of hemorrhoidectomy. Semin Colon Rectal Surg 2015; 26: 168-173
• 2 de Nucci G, Reati R, Arena I. et al. Efficacy of a novel self-assembling peptide hemostatic gel as rescue therapy for refractory acute gastrointestinal bleeding. Endoscopy 2020; 52: 773-779
• 3 Gagliardi M, Sica M, Oliviero G. et al. Endoscopic application of Purastat in the treatment of solitary rectal ulcer syndrome. J Gastrointestin Liver Dis 2021; 30: 324

Publication History

Article published online:
17 March 2023