title: Underlying functional bowel disorder may explain patient dissatisfaction after haemorrhoidal surgery.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  Persistent pain remains the major long-term factor associated with dissatisfaction after surgery for haemorrhoids.
authors.affiliation: Gastroenterology Unit, Rennes University Hospital, Rennes Cedex, France.
authors.forename: C
authors.initials: C
authors.lastname: Favreau
authors.forename: L
authors.initials: L
authors.lastname: Siproudhis
authors.forename: M
authors.initials: M
authors.lastname: Eleouet
authors.forename: G
authors.initials: G
authors.lastname: Bouguen
authors.forename: J-F
authors.initials: JF
authors.lastname: Bretagne
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003248:Constipation / Q000150:complications*; D005242:Fecal Incontinence / Q000150:complications*; D005260:Female; D005500:Follow-Up Studies; D006484:Hemorrhoids / Q000150:complications / Q000601:surgery*; D006801:Humans; D043183:Irritable Bowel Syndrome / Q000150:complications*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D057234:Preoperative Period; D012189:Retrospective Studies; D057566:Self Report