Complications Following Anorectal Surgery

Abstract

Anorectal pathology is prevalent throughout the world, with most anorectal complaints being transient and without the need for formal medical evaluation. For those that do require surgical intervention for their anorectal pathology, the surgery can usually be done safely in the outpatient setting with minimal morbidity. However, no intervention is without risk, and complications frequently arise after anorectal surgery, with rates upward of 50% in some studies. 1 The purpose of this chapter is to review the short-and long-term complications that can arise after anorectal surgery, including the diagnostic approach, interventions, and prevention strategies for these complications. Short-Term/Acute Complications Postoperative HemorrhageMinor bleeding after anorectal surgery is common. Since we expect patients to continue with normal bowel function, the already disturbed anorectal mucosal becomes further irritated with activity and bowel movements. Since some bloody discharge is normal, the patient should be appropriately counseled on what to expect so as to avoid unnecessary anxiety and phone calls. It may also be helpful to remove/wash out clots from the rectum while still in the operating room to minimize confusion after surgery. However, major bleeding can also occur, albeit rarely, and may require further intervention. While the presentation of major bleeding is not uniform, patients often report frequent passing of small to moderate amounts of clot and bright red blood starting after the first bowel movement.Hemorrhoid surgery involves the vascular cushions of the anus, so not surprisingly, hemorrhoidectomy is associated with higher rates of bleeding when compared with other anorectal procedures. 1-3 Bleeding after other anorectal procedures such as procedures for anal fistula or fissure is very low (0.4-1.2%). 4,5 Rates of clinically significant bleeding after hemorrhoid surgery vary based on type of the procedure. For conventional hemorrhoidectomy (Milligan-Morgan and Ferguson) and bipolar energy device hemorrhoidectomy (Ligasure), rates of clinically significant hemorrhage has been reported in the range of 0.3 to 6%, with an average of around 2%. 1-3,6,7 There does not seem to be a significant difference in rates of bleeding between conventional hemorrhoidectomy and bipolar energy device assisted procedures.The timing of bleeding after hemorrhoidectomy varies, and can be generally divided into immediate and delayed. 5 Immediate bleeding occurs within 24 to 48 hours of a procedure and is likely related to loss of control of the vascular pedicle. Delayed bleeding is defined as bleeding reported up to 2 weeks postprocedure, and is more often related to infection or local trauma. 4,5 Delayed bleeding may be influenced by post-operative pain medications. Hemorrhoidectomy is associated with significant postoperative pain, and multimodality management is routinely employed to help alleviate discomfort. NSAIDS are an integral part of this pain management and can increase the incidence of bleeding. 8 Keywords ► anor...

Geleneksel diyatermi ile kıyaslandığında harmonik bistürinin hemoroidektomide faydası var mıdır?

“…Early postoperative hemorrhage is defined as immediate bleeding which happens within the early postoperative period from 24 to 48 hours and is likely related to the loss of control of the vascular pedicle. Delayed bleeding is defined as a hemorrhage reported up to 2 weeks postoperatively, and is more often related to infection or local trauma [16]. Considering the bleeding rates in the present study, it was in agreement with the literature even though the definition of hemorrhage differs.…”

Consensus statement of the Italian society of colorectal surgery (SICCR): management and treatment of hemorrhoidal disease

“…For conventional hemor rhoidectomy (Milligan-Morgan and Ferguson) and bipolar energy device hemorrhoidectomy (LigaSure), rates of bleeding between 0 and 49% have been reported. Clinically significant bleeding has been reported in 0.3-6% of patients, with an average of around 2%, and need of reintervention between 1-2%, without a significant difference in rates of bleeding between the procedures [121,182,183].…”

“…Bleeding after RBL normally occurs between 5 and 14 days after treatment, probably due to the sloughing of the ligated hemorrhoids [182].…”

“…In case of fibrotic anal sphincter, sphincterotomy (unilateral or bilateral) may be considered. On the contrary, patients with stenosis of the anoderm are usually treated with flap (multiple types) or anoplasty, aiming to replace local fibrosis with healthy, elastic tissue [182]. Flap procedures and sphincteroplasty can be associated, in selected patients, while simple release of a stricture may provide temporary relief of symptoms, but generally should be avoided because of the high rate of recurrence.…”

Bilevel-Bilateral Sacral Erector Spinae Plane Block for Chronic Pain Management: A Case Report and Short Literature Review

“…The treatment of endstage cancer pain is challenging due to the side effects of opioids and its nature in a way to require interventional approaches. It has been reported that persistent pain may develop at a rate of 1.5-3.5% after the transanal rectal resection (12). The underlying cause is primarily taken into consideration in terms of the treatment of chronic anorectal pain; unfortunately, there is no consensus concerning the treatment process (13).…”