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One‐year outcome of haemorrhoidectomy: a prospective multicentre French study
Author(s) -
Bouchard D.,
Abramowitz L.,
Castinel A.,
Suduca J. M.,
Staumont G.,
Soudan D.,
Devulder F.,
Pigot F.,
Varastet M.,
Ganansia R.
Publication year - 2013
Publication title -
colorectal disease
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.029
H-Index - 89
eISSN - 1463-1318
pISSN - 1462-8910
DOI - 10.1111/codi.12090
Subject(s) - medicine , anal stenosis , surgery , anal fissure , anal fistula , constipation , prospective cohort study , anal canal , quality of life (healthcare) , observational study , fecal impaction , visual analogue scale , urinary retention , impaction , hemorrhoids , fistula , rectum , nursing
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.