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

• Published in: Colorectal disease Vol. 15; no. 6; pp. 719 - 726
• Main Authors: Bouchard, D., Abramowitz, L., Castinel, A., Suduca, J. M., Staumont, G., Soudan, D., Devulder, F., Pigot, F., Varastet, M., Ganansia, R.
• Format: Journal Article
• Language: English
• Published: England Blackwell Publishing Ltd 01.06.2013
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Anal Canal - surgery; anal incontinence; Cohort Studies; faecal incontinence; Female; Fissure in Ano - complications; Fissure in Ano - surgery; Haemorrhoidectomy; haemorrhoids; Hemorrhoidectomy; Hemorrhoids - complications; Hemorrhoids - surgery; Humans; Leopold Bellan procedure; Longitudinal Studies; Male; Middle Aged; Patient Satisfaction; Postoperative Complications; Prospective Studies; quality of life; Rectal Fistula - complications; Rectal Fistula - surgery; Recurrence; Reoperation - statistics & numerical data; Treatment Outcome; Young Adult
• ISSN: 1462-8910; 1463-1318
• DOI: 10.1111/codi.12090

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.