Prospective survey of secondary bleeding following  anorectal surgery in a consecutive series of  1,269 patients.
BACKGROUND
As little data is available about secondary bleeding after proctological surgery, we conducted a specific survey.


METHODS
Patients operated between November 2008 and April 2009 were prospectively included. Patients were followed until last visit (day 21-28). Severity of bleeding was low (at home stay), moderate (hospitalisation for observation), or severe (transfusion, and/or homeostasis in operating room).


RESULTS
Included were 1269 patients: haemorrhoidectomy/pexy 527 (41%), fistula treatment 273 (21%), fissurectomy 197 (15%), perianal and pilonidal abscesses 124 (10%), others 148 (12%). Before surgery 78 patients were under long-term treatment with antiplatelet or anticoagulant therapy. Seventy-eight patients (6%) demonstrated 85 bleeding events. Severity rate was: low 22%, moderate 51%, and severe 27%. Ninety-five percent of events occurred before day 15. Univariate study showed increased risk after haemorrhoidopexy (P<10-3) and anticoagulant treatment (P = 0.002), decreased risk after fissurectomy and fistulotomy (P<10-3), and no relation with age, sex or operator. After multivariate study only relationship with anticoagulant treatment remained significant.


CONCLUSIONS
Secondary bleeding occurred in 6% of patients after proctological surgery, requiring a readmission and/or an active treatment in about 75%. Treatment with anticoagulant exposed to increased bleeding frequency.
Hôpital Bagatelle, 201, rue Robespierre, 33401 Talence cedex, France. proctobagatelle@mspb.com
F
F
Pigot
F
F
Juguet
D
D
Bouchard
A
A
Castinel
J-P
JP
Vove
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001003:Anal Canal / Q000601:surgery*; D002648:Child; D003625:Data Collection; D013505:Digestive System Surgical Procedures / Q000009:adverse effects; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019106:Postoperative Hemorrhage / Q000453:epidemiology* / Q000209:etiology; D011446:Prospective Studies; D012007:Rectum / Q000601:surgery*; D012720:Severity of Illness Index; D055815:Young Adult