Risk Factors of Recurrent Hemorrhoid after Primary Management

ABSTRACT

Before surgery for hemorrhoid, patients always have a worry of postoperative recurrence. The exact incidence and risk factors of recurrent hemorrhoid have not yet been delineated up to now. Therefore, the aim of this study was to assess the etiology of the recurrence after surgery. MATERIAL AND METHODS: Between March, 1997 and Feburary 1998, all patients who visited the Dept. of Surgery, Korea Veteran Hosipital, due to the recurrent hemorroid after surgical managememt including sclerotherapy(Group II GII, n=60) were compared to the age and sex mathed(12) with primary hemorroid patients(group I GI, n=120). The risk factors which might be related with the recurrence such as 1) hemorroidal factor(duration of symtom, symtom, associated perinial disease) 2) patient factor (constipation, incontience, cardiovascular disease, pulmonary and hepatic disease) 3) anorectal physiologic factors 4) surgical factors were evaluated. Stastical analysis were performed by a chi-square-test or Mann-Whitney U test and set the significance at p<0.05. RESULTS: There were no differences between the two groups in terms of age(GI 58.1+/-8.5, GII 60.9+/-3.3 years), gender(MF, GI; 9723, GII; 564 ). The ratio of having a contipation before surgery was 41% in GI, 55% in GII. It was not statistically significant. However, the other factors related with constipation such as duration of constipation(GI; 9.85+/-7.73 years, GII; 14.62+/-7.38 years p<0.05), duration of straining during defecation(GI; 5.82+/-2.34, GII; 7.32+/-5.6 minutes, p<0.05) number of laxative use(GI; 29, GII; 28) were significantly different between the two groups. The fecal incontince are 5% in group Iand 13% in group II. There were no differences in patient's subject symtoms related with hemorrhoid, and comorbid perianal disease between the two groups. In anorectal manometric findings, rectal complince was significantly lower in GII than that of GI(25.1+/-50.04 cc/cmH20 vs 16.0+/-25.2 cc/cmH20 p<0.05). GII has a significant number of preopertive hypertension than GI(6.7% vs. 21.6%, p<0.05). CONCLUSION: When a patient with hemorrhoid has a constipation or hypertension, and lower compliance in manometric findings, it would be related with the postoperative recurrence after treatment. Therefore, we surgeons should correct these comorbid conditions before surgery, otherwise give an information to the patient of high chance of postoperative recurrence after management.