A comparison of early postoperative results between urgent closed hemorrhoidectomy for prolapsed thrombosed hemorrhoids and elective closed hemorrhoidectomy.
OBJECTIVE
To compare the perioperative complications, analgesics requirement, and length of hospital stay between patients undergoing urgent closed hemorrhoidectomy for prolapsed thrombosed hemorrhoid and elective closed hemorrhoidectomy.


METHODS
Retrospective, comparative study.


METHODS
All records of the patients who underwent urgent and elective hemorrhoidectomy between January 2000 and December 2005 were reviewed. Perioperative complications (bleeding, urinary retention, post-operative thrombosis, and wound dehiscence), analgesic requirement, and length of hospital stay were analyzed.


METHODS
Chi-Square Test and Mann-Whitney U Test.


RESULTS
From 1440 patients, 1184 patients met the inclusion criteria. All were done with closed technique. The indication for urgent hemorrhoidectomy was prolapsed thrombosed hemorrhoid in 416 patients (group 1). The indication for elective hemorrhoidectomy were grade 3 and 4 internal hemorrhoid, external hemorrhoid or combined hemorrhoid in 768 patients (group 2). There was no statistically significant difference in urinary retention and bleeding complication between two groups; 31 patients (7.5%) in group 1 and 69 patients (8.9%) in group 2 experienced urinary retention p = 0.426, five patients (1.2%) in group 1 and 10 patients (1.3%) in group 2 had postoperative bleeding, p = 1.000). On the second postoperative week, wound dehiscence was found in nine patients (2.2%) from group 1 and 15 patients (2%) from group 2. On the fourth week, all the wounds were completely healed without granulation or stricture formation. Post-operative meperidine requirement was significantly lower in the urgent hemorrhoidectomy group (0.84 +/- 0.71 vs. 0.99 + 0.81 mg/kg, p < 0.001). Post-operative length of hospital stay were not statistically different (1.017 +/- 0.129 vs. 1.016 +/- 0.124, p = 0.107).


CONCLUSIONS
Urgent closed hemorrhoidectomy for prolapsed thrombosed hemorrhoids may be a preferable option for patients suffering from this condition.
Pattana-arun
Jirawat
J
Division ofColorectal Surgery, Department of Surgery, Chulalongkorn University Bangkok, Thailand.
Wesarachawit
Warin
W
Tantiphlachiva
Kasaya
K
Atithansakul
Puttarat
P
Sahakitrungruang
Chucheep
C
Rojanasakul
Arun
A
D000082:Acetaminophen / Q000627:therapeutic use; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000701:Analgesics, Opioid / Q000627:therapeutic use; D017558:Elective Surgical Procedures / Q000706:statistics & numerical data*; D005260:Female; D006484:Hemorrhoids / Q000601:surgery*; D006801:Humans; D008297:Male; D008614:Meperidine / Q000627:therapeutic use; D008875:Middle Aged; D010149:Postoperative Pain / Q000188:drug therapy; D059035:Perioperative Period; D011184:Postoperative Period; D011351:Proctoscopy / Q000295:instrumentation / Q000379:methods*; D012005:Rectal Prolapse / Q000601:surgery*; D012189:Retrospective Studies; D013785:Thailand; D013927:Thrombosis / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
D000701:Analgesics, Opioid; D000082:Acetaminophen; D008614:Meperidine