title: Tamponade dressings may be unnecessary after haemorrhoidectomy: a randomised controlled clinical trial.
abstract: OBJECTIVE
  Bleeding after haemorrhoidectomy is common. Many surgical textbooks recommend insertion of an anal tampon in order to reduce postoperative bleeding. This practice, however, is bothersome and probably painful for patients. The effect of using a tamponade has not been validated in randomised controlled trials.
  
  
  METHODS
  The study included 100 patients who were scheduled for Milligan-Morgan haemorrhoidectomy. During surgery, patients were randomly assigned to receive or not to receive an anal tampon at the end of the procedure. Data on pain, complications and wound care were collected. The trial was registered (DRKS00003116) and all analyses were by intention-to-treat.
  
  
  RESULTS
  There were 48 patients in the group with tamponade, and 52 patients were left without tamponade. The trial's primary outcome and maximum pain intensity, averaged 6.1 and 4.2 in the two groups (P = 0.001). In the group with tamponade, a complication was recorded in seven patients (15 %), which was similar to the group without tamponade (21 %). Severe anal bleeding occurred in two and five patients, respectively. Bandage changes were less necessary often in the group treated without tamponade (P = 0.013). Hospital stay was 4 days in both groups.
  
  
  CONCLUSIONS
  Data indicate that insertion of an anal tampon after haemorrhoidectomy does not reduce postoperative bleeding but causes significantly more pain. After haemorrhoidectomy, anal tampons should not be used routinely but may be considered when specific indications justify its use.
authors.affiliation: Helios St. Elisabeth Klinik Oberhausen, Department of Surgery II, University of Witten/Herdecke, Oberhausen, Germany, mike-ralf.langenbach@helios-kliniken.de.
authors.forename: Mike Ralf
authors.initials: MR
authors.lastname: Langenbach
authors.forename: Stratos
authors.initials: S
authors.lastname: Chondros
authors.forename: Stefan
authors.initials: S
authors.lastname: Sauerland
mesh_terms: D000328:Adult; D000368:Aged; D001003:Anal Canal / Q000502:physiology; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000517:prevention & control*; D061865:Hemorrhoidectomy / Q000009:adverse effects; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000209:etiology; D011312:Pressure; D013630:Tampons, Surgical / Q000009:adverse effects*