Underlying functional bowel disorder may explain patient dissatisfaction after haemorrhoidal surgery

• Published in: Colorectal disease Vol. 14; no. 3; pp. 356 - 361
• Main Authors: Favreau, C., Siproudhis, L., Eleouet, M., Bouguen, G., Bretagne, J.-F.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01.03.2012; Wiley
• Subjects: Adult; Aged; Aged, 80 and over; Constipation; Constipation - complications; Fecal Incontinence; Fecal Incontinence - complications; Female; Follow-Up Studies; haemorrhoidectomy; Hemorrhoids; Hemorrhoids - complications; Hemorrhoids - surgery; Human health and pathology; Humans; Hépatology and Gastroenterology; incontinence; Irritable Bowel Syndrome; Irritable Bowel Syndrome - complications; Life Sciences; Logistic Models; Male; Middle Aged; Pain, Postoperative; Patient Satisfaction; Patient Satisfaction - statistics & numerical data; Preoperative Period; Retrospective Studies; satisfaction; Self Report; Stapled haemorrhoidopexy; Stapled haemorrhoidopexy; incontinence; haemorrhoidectomy; satisfaction
• ISSN: 1462-8910; 1463-1318
• DOI: 10.1111/j.1463-1318.2011.02612.x

Aim  The aim of this study was to assess patient dissatisfaction and functional symptoms following haemorrhoid surgery, aspects of which are seldom covered in other published series. Method  A self‐administered questionnaire was mailed to 359 consecutive patients (prospective database; 198 men, 161 women; median follow up, 59 [1–120] months) who underwent either Milligan‐Morgan haemorrhoidectomy (n = 205) or stapled haemorrhoidopexy (n = 154). Results  The response rate was 72%; 2.4% of patients had no opinion, 13.6% were dissatisfied, 33.0% were satisfied, and 51.0% were very satisfied with the treatment. Dissatisfied patients were more likely to be women and more likely to have a long history of constipation and irritable bowel syndrome. The duration of surgery and the rates of pre‐ and postoperative complications did not differ between groups. Residual bleeding (49%vs 32%), prolapse (67%vs 31%) and pain (91%vs 55%) occurred more frequently in the dissatisfied group compared with the satisfied group (P < 0.001). Incontinence (4 [0–16] vs 1 [0–15]; P = 0.0003) and constipation (19 [1–34] vs 8 [0–31]; P < 0.0001) scores were significantly higher in the dissatisfied group compared with satisfied patients. Anal pain was the predominant symptom associated with dissatisfaction in a logistic regression model. Conclusion  Persistent pain remains the major long‐term factor associated with dissatisfaction after surgery for haemorrhoids.