E. Inoue1,2, Y. Shimojima1, M. Matsushima1 1Matsushima Hospital,Coloproctology Center,Tobe Honcho, YOKOHAMA, Japan 2Yokohama City University Medical Center,Inflammatory Bowel Disease Center,Urafune, YOKOHAMA, Japan
Introduction:
Posthemorrhoidectomy secondary hemorrhage (PHSH) is a rare but serious complication after hemorrhoidectomy. The aim was to identify risk factors for this complication and that may provide information to improve outcome.
Methods:
We studied 1813 patients who underwent hemi – closed hemorrhoidectomies in a single institution between January and December 2015. The hemi – closed hemorrhoidectomy is a most common procedure in Japan. That is subsequently Millligan-Morgan procedure, close anal canal wound with a continuous suture to anal verge, it’ on this point that this procedure is different from Ferguson’s one. The hemi – closed hemorrhoidectomy is purported to be a less painful and reduce the wound infection rate. 50 patients were developed PHSH (PHSH group), whereas the remainder were classified to the non-PHSH group. The variables analyzed included age, gender, the required time for defecation, Goligher grade, anticoagulant agents, suture materials, operation time, intraoperative bleeding, and number of hemorrhoid excisions for each patient. The logistic regression model was used to assess the independent association of variables with PHSH.
Results:
Among the all patients, 50 developed PHSH (2.76%), and the mean period between operation and PHSH was 8.1 ± 4.8 days. Multivariate analysis revealed that patient’s gender, intraoperative bleeding, and number of hemorrhoid excisions for each patient were independently associated with risk of PHSH. Male patients were more likely than females to develop PHSH (relative risk, 2.04 ; 95 percent confidence interval, 1.10-3.81 ; P < 0.001). Intraoperative bleeding was 62.7±89.4 (ml) in the PHSH group, whereas that was 30.2±39.6 (ml) in the non-PHSH group (relative risk, 1.01 ; 95 percent confidence interval, 1.00-1.01 ; P < 0.001).Under two hemorrhoid excisions for each patient were lower than three and more hemorrhoid excisions to develop PHSH (relative risk, 0.40 ; 95 percent confidence interval, 0.22-0.73 ; P < 0.001).
Conclusion:
Our data suggest that the male patients, the amount of intraoperative bleeding, and more than three hemorrhoid excisions are highly correlated with this risk.