One‐year outcome of haemorrhoidectomy: a prospective multicentre French study

Aim An evaluation was performed of the 1‐year outcome of open haemorrhoidectomy (Milligan and Morgan alone or with posterior mucosal anoplasty [the Leopold Bellan procedure]). Method A prospective, multicentre, observational study included all patients having a planned haemorrhoidectomy from January 2007 to June 2008. Data were collected before surgery, and at 3 months and 1 year after surgery. Patients assessed their anal symptoms and quality of life ( SF ‐36). Results Six‐hundred and thirty‐three patients (median age = 48 years, 56.5% women) underwent haemorrhoidectomy either by the Milligan and Morgan procedure alone ( n  =   231, 36.5%) or together with the Leopold Bellan procedure (posterior mucosal anoplasty) for resection of a fourth haemorrhoid ( n  =   345, 54.5%), anal fissure ( n  =   56, 8.9%) or low anal fistula ( n  =   1, 0.16%). The median healing time was 6 weeks. Early complications included urinary retention ( n  =   3), bleeding ( n  =   11), local infection ( n  =   7) and faecal impaction ( n  =   9). At 1 year, the main complications included skin tags ( n  =   2) and anal stenosis ( n  =   23). There were three recurrences requiring a second haemorrhoidectomy. On a visual analogue scale, anal pain at 1 year had fallen from a median of 5.5/10 before treatment to 0.1/10 (p < 0.001), anal discomfort from 5.5/10 to 0.1/10 ( P  < 0.001) and the Knowles–Eckersley–Scott Symptom ( KESS ) constipation score from 9/45 to 6/45 ( P  < 0.001). The median Wexner score for anal incontinence was unchanged (2/20). De‐novo anal incontinence (a Wexner score of >5) affected 8.5% of patients at 1 year, but preoperative incontinence disappeared in 16.7% of patients with this symptom. All physical and mental domains of quality of life significantly improved, and 88% of patients were satisfied or very satisfied. Conclusion Complications of open haemorrhoidectomy were infrequent. Anal continence was not altered. Comfort and well‐being were significantly improved at 1 year after surgery. Patient satisfaction was high despite residual anal symptoms.