Risk of delayed bleeding after hemorrhoidectomy

Lee, Ko‐Chao; Liu, Chia-Cheng; Hu, Wan-Hsiang; Lu, Chun‐Wei; Lin, Shu Min; Chen, Hong‐Hwa

doi:10.1007/s00384-018-3176-6

Cited by 29 publications

(24 citation statements)

References 30 publications

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“…Secondary haemorrhage usually arises as a consequence of infection in the haemorrhoidectomy wound and can occur between days 7 and 14 postoperatively. It affects approximately 5% of patients undergoing conventional haemorrhoidectomy [62]. Bleeding is often brisk and will require admission to hospital, fluid resuscitation, and examination under anaesthesia.…”

Section: Complications Of Haemorrhoidectomymentioning

confidence: 99%

Still a Case of “No Pain, No Gain”? An Updated and Critical Review of the Pathogenesis, Diagnosis, and Management Options for Hemorrhoids in 2020

Young

2020

Ann Coloproctol

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The treatment of haemorrhoids remains challenging: multiple treatment options supported by heterogeneous evidence are available, but patients rightly demand a tailored approach. Evidence for newer surgical techniques that promise to be less painful has been conflicting. We review the current evidence for management options in patients who present with varying haemorrhoidal grades. A review of the English literature was performed utilizing MEDLINE/PubMed, Embase, and Cochrane databases (31 May 2019). The search terms (haemorrhoid OR haemorrhoid OR haemorrhoids OR haemorrhoids OR “Hemorrhoid”[Mesh]) were used. First- and second-degree haemorrhoids continue to be managed conservatively. The easily repeatable and cost-efficient rubber band ligation is the preferred method to address minor haemorrhoids; long-term outcomes following injection sclerotherapy remain poor. Conventional haemorrhoidectomies (Ferguson/Milligan-Morgan/Ligasure haemorrhoidectomy) still have their role in third- and fourth-degree haemorrhoids, being associated with lowest recurrence; nevertheless, posthaemorrhoidectomy pain is problematic. Stapled haemorrhoidopexy allows quicker recovery, albeit at the costs of higher recurrence rates and potentially serious complications. Transanal Haemorrhoidal Dearterialization has been promoted as nonexcisional and less invasive, but the recent HubBLe trial has questioned its overall place in haemorrhoid management. Novel “walk-in-walk-out” techniques such as radiofrequency ablations or laser treatments will need further evaluation to define their role in modern-day haemorrhoid management. There are numerous treatment options for haemorrhoids, each with their own evidence-base. Newer techniques promise to be less painful, but recurrence rates remain an issue. The balance continues to be sought between long-term efficacy, minimisation of postoperative pain, and preservation of anorectal function.

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Section: Complications Of Haemorrhoidectomymentioning

confidence: 99%

Still a Case of “No Pain, No Gain”? An Updated and Critical Review of the Pathogenesis, Diagnosis, and Management Options for Hemorrhoids in 2020

Young

2020

Ann Coloproctol

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“…It is possible that in our series energy devices were used in the more complex cases or for more extensive surgery, thus introducing a selection bias in favour of diathermy. A recent study by Lee et al [19] also showed that LigaSure devices increase the risk of delayed postoperative bleeding. They suggest that because LigaSure devices result in decreased postoperative pain and earlier return to normal activity, patients may be more likely to engage in physical activity at an earlier stage.…”

Section: Discussionmentioning

confidence: 94%

“…A recent study by Lee et al . also showed that LigaSure devices increase the risk of delayed postoperative bleeding. They suggest that because LigaSure devices result in decreased postoperative pain and earlier return to normal activity, patients may be more likely to engage in physical activity at an earlier stage.…”

Section: Discussionmentioning

confidence: 94%

Risk factors associated with unplanned readmission following excisional haemorrhoidectomy

et al. 2019

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Aim Excisional haemorrhoidectomy is the gold standard for management of advanced symptomatic haemorrhoids. Although an effective treatment, it is associated with significant postoperative morbidity with pain, bleeding and a high readmission rate. This study seeks to investigate potential risk factors that may predict unplanned 30-day readmissions following excisional haemorrhoidectomy.Method A retrospective cohort review of all haemorrhoidectomies performed at Counties Manukau District Health Board, Auckland, New Zealand, between January 2012 and December 2017 was performed. Baseline demographic data, readmission data and potential variables for readmission were recorded. Univariate and multivariate logistic regression analyses were performed to determine significant variables for readmission within 30 days. ResultsIn total, 485 cases of excisional haemorrhoidectomy were included in the final analysis with 62 (12.8%) unplanned readmissions. The demographics between the no readmission and unplanned readmission groups were similar. Multivariate logistic regression analysis demonstrated that male gender (P = 0.018) and the use of non-diathermy devices (P = 0.017) were significant risk factors for readmission. Initial dispensing of opioid analgesia did not decrease the risk of readmission.Conclusion This study suggests that male gender and surgical technique are associated with increased risk of readmission.What does this paper add to the literature? Haemorrhoids are a common anorectal disease, with symptomatic and advanced cases requiring excisional haemorrhoidectomy for definitive treatment. Although effective, the operation is associated with significant pain and bleeding which results in hospital readmission. This study suggests that male gender and use of non-diathermy devices are associated with increased readmission.

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“…The incidence of delayed postoperative haemorrhage has been reported to be 0.9-10%. 12 It is also seen that there is no difference in post-operative bleeding between haemorrhoidectomy done in elective and those done on an emergency setting.…”

Section: Discussionmentioning

confidence: 99%

Uncontrolled per rectal bleeding in chronic myeloid leukaemia: a mere coincidence or a dangerous sign report of an unusual case

Ali¹,

Singh²,

Joshi³

et al. 2020

Int Surg J

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Bleeding haemorrhoids present commonly to surgical outpatient departments (OPDs) and sometimes in emergency. Most often conservative management suffices but infrequently the patients can land up in emergency operation theatre for uncontrolled bleeding. Some haematological disorders can also present with rectal bleeding and amongst them Chronic myeloid leukaemia (CML), a haematological malignancy, presenting as bleeding per rectum has been not been reported so far, though instances of CML with gingival bleed, epistaxis have been reported. CML per se is known to be asymptomatic (40% cases) and bleeding is rarely seen. Here we present an interesting case of an emergency hemorrhoidal bleed that was subsequently diagnosed as CML. The patient after failed conservative management for bleeding haemorrhoids was taken up for emergency haemorrhoidectomy and again a relook under general anaesthesia in the post-operative period as he continued to ooze. The total leucocyte counts which were initially high continued to rise further and the bone marrow examination was reported as chronic myeloproliferative neoplasm and the excised mass was consistent with haemorrhoids. Rectal bleeding associated with CML is so far unreported even though bleeding is seen due to platelet dysfunction from gums and nose in chronic phases of the disease. A high index of suspicion is needed particularly with deranged haematological parameters for considering a diagnosis of these rare presentations. and anaesthesia.

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Risk of delayed bleeding after hemorrhoidectomy

Cited by 29 publications

References 30 publications

Still a Case of “No Pain, No Gain”? An Updated and Critical Review of the Pathogenesis, Diagnosis, and Management Options for Hemorrhoids in 2020

Still a Case of “No Pain, No Gain”? An Updated and Critical Review of the Pathogenesis, Diagnosis, and Management Options for Hemorrhoids in 2020

Risk factors associated with unplanned readmission following excisional haemorrhoidectomy

Uncontrolled per rectal bleeding in chronic myeloid leukaemia: a mere coincidence or a dangerous sign report of an unusual case

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