title: One-year outcome of haemorrhoidectomy: a prospective multicentre French study.
abstract: OBJECTIVE
  An evaluation was performed of the 1-year outcome of open haemorrhoidectomy (Milligan and Morgan alone or with posterior mucosal anoplasty [the Leopold Bellan procedure]).
  
  
  METHODS
  A prospective, multicentre, observational study included all patients having a planned haemorrhoidectomy from January 2007 to June 2008. Data were collected before surgery, and at 3 months and 1 year after surgery. Patients assessed their anal symptoms and quality of life (SF-36).
  
  
  RESULTS
  Six-hundred and thirty-three patients (median age = 48 years, 56.5% women) underwent haemorrhoidectomy either by the Milligan and Morgan procedure alone (n = 231, 36.5%) or together with the Leopold Bellan procedure (posterior mucosal anoplasty) for resection of a fourth haemorrhoid (n = 345, 54.5%), anal fissure (n = 56, 8.9%) or low anal fistula (n = 1, 0.16%). The median healing time was 6 weeks. Early complications included urinary retention (n = 3), bleeding (n = 11), local infection (n = 7) and faecal impaction (n = 9). At 1 year, the main complications included skin tags (n = 2) and anal stenosis (n = 23). There were three recurrences requiring a second haemorrhoidectomy. On a visual analogue scale, anal pain at 1 year had fallen from a median of 5.5/10 before treatment to 0.1/10 (p < 0.001), anal discomfort from 5.5/10 to 0.1/10 (P < 0.001) and the Knowles-Eckersley-Scott Symptom (KESS) constipation score from 9/45 to 6/45 (P < 0.001). The median Wexner score for anal incontinence was unchanged (2/20). De-novo anal incontinence (a Wexner score of >5) affected 8.5% of patients at 1 year, but preoperative incontinence disappeared in 16.7% of patients with this symptom. All physical and mental domains of quality of life significantly improved, and 88% of patients were satisfied or very satisfied.
  
  
  CONCLUSIONS
  Complications of open haemorrhoidectomy were infrequent. Anal continence was not altered. Comfort and well-being were significantly improved at 1 year after surgery. Patient satisfaction was high despite residual anal symptoms.
authors.affiliation: Service de Proctologie, Hôpital Bagatelle, Talence, France. proctobouc@gmail.com
authors.forename: D
authors.initials: D
authors.lastname: Bouchard
authors.forename: L
authors.initials: L
authors.lastname: Abramowitz
authors.forename: A
authors.initials: A
authors.lastname: Castinel
authors.forename: J M
authors.initials: JM
authors.lastname: Suduca
authors.forename: G
authors.initials: G
authors.lastname: Staumont
authors.forename: D
authors.initials: D
authors.lastname: Soudan
authors.forename: F
authors.initials: F
authors.lastname: Devulder
authors.forename: F
authors.initials: F
authors.lastname: Pigot
authors.forename: M
authors.initials: M
authors.lastname: Varastet
authors.forename: R
authors.initials: R
authors.lastname: Ganansia
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001003:Anal Canal / Q000601:surgery*; D015331:Cohort Studies; D005260:Female; D005401:Fissure in Ano / Q000150:complications / Q000601:surgery*; D061865:Hemorrhoidectomy; D006484:Hemorrhoids / Q000150:complications / Q000601:surgery*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D011183:Postoperative Complications; D011446:Prospective Studies; D012003:Rectal Fistula / Q000150:complications / Q000601:surgery*; D012008:Recurrence; D012086:Reoperation / Q000706:statistics & numerical data; D016896:Treatment Outcome; D055815:Young Adult