Analysis of risk factors for delayed bleeding after semi-closed hemorrhoidectomy.

PURPOSE: The aim of this study was to determine the incidence of delayed post-hemorrhoidectomy bleeding (DPHB) after hemorrhoidectomy using a semi-closed procedure. We also investigated risk factors associated with DPHB. METHODS: This retrospective study enrolled a total of 1645 consecutive patients with symptomatic grade II to IV hemorrhoids who underwent a semi-closed procedure at the Seoul Songdo Hospital between September 2018 and May 2019. All patients underwent a semi-closed procedure with submucosal feeding vessel ligation, a method commonly performed at our institution. RESULTS: A total of 1645 patients (mean age: 48.67 (±14.38) years, 823 (50.0%) male/822 (50.0%) female) underwent semi-closed hemorrhoidectomy. Critically, 24 (1.5%) patients experienced DPHB. Of these patients, 13 (0.8%) experienced stump bleeding, whereas 11 (0.7%) experienced marginal bleeding. The mean bleeding period was 8.21±4.45 days. Multivariate analysis showed that male sex, drinking history, more than four hemorrhoid piles, and laxative agents were independent risk factors for DPHB. The risk of stump bleeding was significantly associated with male sex (OR=5.55, 95% CI 1.23-25.14, p=0.026), more than four hemorrhoid piles (OR=5.90, 95% CI 1.62-21.53, p=0.007), and laxative usage (OR=3.92, 95% CI 1.31-11.74, p=0.015). Conversely, the risk of marginal bleeding were significantly associated with drinking history (OR=10.48, 95% CI 1.34-82.03, p=0.025) and more than four hemorrhoid piles (OR=4.71, 95% CI 1.24-17.81, p=0.023). CONCLUSION: Male sex, drinking history, more than four hemorrhoid piles, and laxative usage were independent risk factors for DPHB in patients undergoing semi-closed hemorrhoidectomy. The risk factors for stump bleeding included male sex, more than four hemorrhoid piles, and laxative usage. In contrast, the risk factors for marginal bleeding were drinking history and more than four hemorrhoid piles.

Clinical study on combination of procedure for prolapse and hemorrhoids and excision-closed hemorrhoidectomy for severe hemorrhoids / 中国医师进修杂志

Objective To demonstrate the feasibility, effectiveness and reliability of combination of procedure for prolapse and hemorrhoids (PPH) and excision-closed hemorrhoidectomy (ECH) for severe hemorrhoids. Methods Sixty patients with Ⅲ- Ⅳ degree hemorrhoids which left remnant prolapsed hemorrhoids after stapled hemorrhoidopexy, were randomly divided into group A (PPH with additional ECH group,30 cases.) and group B [PPH with additional Milligan-Morgan hemorrhoidectomy (MMH) group, 30 cases]. Ten indexes of the results in two groups were compared. ResultsThe hemorrhoidectomy lasted (35.6 ± 5.3) min in group A and (47.3 ± 10.2) min in group B. The indexes related to 24 h visual analogue scale (VAS) after operation were (2.9 ± 1.2) scores in group A and (5.7 ± 1.9) scores in group B. Wound healing time were (6.3 ± 1.4) d in group A and (28.5 ± 4.8) d in group B. Many indexes showed the results in group A was better than those in group B ( P ＜ 0.05 ). The six-month follow-up visits after operation showed no complications, such as recurrence in either group. ConclusionsCombination treatment for Ⅲ -Ⅳ degree hemorrhoids with PPH with additional ECH is a easy,safe,reliable,minimal-aching and quick-recovering method of hemorrhoidectomy with favorable results than PPH with additional MMH.

Open Hemorrhoidectomy

The open hemorrhoidectomy has been recognized as the treatment of choice for symptomatic prolapsing hemorrhoids. Although the open hemorrhoidectomy is thought to be associated with more postoperative pain and delayed wound healing compared with other conventional procedures such as a closed hemorrhoidectomy, and a semi- closed or submucosal hemorrhoidectomy, it is still unclear which procedure is preferable in terms of postoperative pain, wound healing, hospital stay, and time off work. To address this issue, several studies have been performed. According to randomized controlled studies comparing an open hemorrhoidectomy to a closed hemorrhoidectomy, there are no significant differences in the severity of pain and the hospital stay between the two procedures; however, the healing time in the closed hemorrhoidectomy is faster and the operation time in the open hemorrhoidectomy is shorter. Since there are few randomized controlled studies comparing an open hemorrhoidectomy with a semi-closed hemorrhoidectomy or submucosal hemorrhoidectomy, it is difficult to conclude which procedure is superior to the others. Yet, there seems to be no significant difference between these procedures. In 1998, a novel procedure, a stapled hemorrhoidopexy, was introduced by Longo. Several randomized controlled studies comparing the open hemorrhoidectomy with the stapled hemorrhoidopexy showed that the latter was associated with less pain, shorter hospital stay, and earlier return to work. However, considering the lack of long- term data and the disastrous complications, such as retroperitoneal sepsis and rectal perforation, there is still controversy about its efficacy and safety as a definitive treatment of hemorrhoids. The open hemorrhoidectomy is time-tested and is comparable to other conventional techniques in terms of postoperative pain, hospital stay, and time off work. Further study should be performed to assess the long-term results of a stapled hemorrhoidopexy.

A Prospective Randomized Trial of Open and Closed Hemorrhoidectomies

BACKGROUND: Open and closed hemorrhoidectomies are the most common surgical treatment methods for hemorrhoids. However, the advantages and the disadvantages of each procedure have not yet delineated. PURPOSE: To compare open and close hemorrhoidectomies. METHODS: A prospective randomized trial of open and closed hemorrhoidectomies was performed between January 1997 and July 1997. All patients who underwent consecutive, surgery by a single surgeon (JSJ) for grade III or IV homorrhoids were classified into two groups : Open (GI) and closed (GII) hemorrhoidectomies. For the comparison of each procedure, the duration of the hospital stay, the patients' complaints, the pain score (Grade 1-10), and the complications after surgery were assessed.. Followup data were also obtained by telephone interviews. For the physiologic comparison, the preoperative and the postoperative anorectal manometry results were evaluated. RESULTS: Fortyone (41) patients were underwent hemorrhoidectomies : GI (n=18) and GII (n=23). There were no differences between the two groups in terms of duration of symptoms, degree of hemorrhoid, age, and gender. There were no differences respect to parameters related with postoperative complaints during the hospital stay, such as pain on defecation, skin edema, and anal itching. However, bleeding on defecation (83% in GI vs. 43.5% in GII, p<0.05), and anal soiling (61% in GI vs. 13% in GII, p<0.05) were significantly higher in GI patients. The pain score on postoperative day 1 was significantly higher in GI (6.6 vs. 4.9, p<0.05). Other parameters of complications (stricture, 5.7% in GI. vs. 4.3% in GII; defecation difficulty; 5.7% in GI vs. 4.3% in GII; and fecal incontinence; 0% in GI vs. 4.3% in GII) showed no significant differance during the mean followup period of 4.7 months. Neither the mean hospital stay (7 days in GI, 6.2 days in GII) nor the period of complete wound healing (32.7 vs 28.3 days in GI, GII, respectively) was different between the two groups. The preoperative and the postoperative anorectal manometric findings were not different in the two groups. CONCLUSIONS: The closed hemorrhoidectomy was superior to the open procedures in terms of some parameters such as the pain score on postoperative day 1, bleeding on defecation, and postoperative soiling during the hospital stay. However, the intermediate postoperative outcomes were not different for the two procedures.