title: Ambulatory haemorrhoidal surgery: systematic literature review and qualitative analysis.
abstract: OBJECTIVE
  The aims of this study are to review the advantages and drawbacks of the ambulatory management of patients scheduled for haemorrhoidal surgery and to highlight the reasons for unplanned hospital admission and suggest preventive strategies.
  
  
  METHODS
  We conducted a systematic review of the literature from January 1999 to January 2013 using MEDLINE and EMBASE databases. Manuscripts were specifically analysed for failure and side effects of haemorrhoidal surgery in ambulatory settings.
  
  
  RESULTS
  Fifty relevant studies (6082 patients) were retrieved from the literature review. The rate of ambulatory management failure ranged between 0 and 61%. The main reasons for failure were urinary retention, postoperative haemorrhage and unsatisfactory pain control. Spinal anaesthesia was associated with the highest rates of urinary retention. Doppler-guided haemorrhoidal artery ligation has less frequent side effects susceptible to impair ambulatory management than haemorrhoidectomy and stapled haemorrhoidopexy. However, the fact that haemorrhoidopexy is less painful than haemorrhoidectomy may allow ambulatory management.
  
  
  CONCLUSIONS
  Day-case haemorrhoidal surgery can be performed whatever the surgical procedure. Postoperative pain deserves special prevention measures after haemorrhoidectomy, especially by using perineal block or infiltrations. Urinary retention is a common issue that can be responsible for failure; it requires a preventive strategy including short duration spinal anaesthesia. Doppler-guided haemorrhoidal artery ligation is easy to perform in outpatients but deserves more complete evaluation in this setting.
authors.affiliation: Department of Visceral and Ambulatory Surgery, Centre Hospitalier Intercommunal de Poissy Saint Germain en Laye, 10 rue du champ Gaillard, BP 73082, 78303, Poissy cedex, France, bvinsonbonnet@gmail.com.
authors.forename: B
authors.initials: B
authors.lastname: Vinson-Bonnet
authors.forename: T
authors.initials: T
authors.lastname: Higuero
authors.forename: J L
authors.initials: JL
authors.lastname: Faucheron
authors.forename: A
authors.initials: A
authors.lastname: Senejoux
authors.forename: F
authors.initials: F
authors.lastname: Pigot
authors.forename: L
authors.initials: L
authors.lastname: Siproudhis
mesh_terms: D000556:Ambulatory Surgical Procedures / Q000009:adverse effects* / Q000379:methods; D061865:Hemorrhoidectomy / Q000009:adverse effects; D006484:Hemorrhoids / Q000601:surgery*; D006801:Humans; D008026:Ligation / Q000009:adverse effects / Q000379:methods; D010149:Postoperative Pain / Q000209:etiology / Q000517:prevention & control; D019106:Postoperative Hemorrhage / Q000517:prevention & control; D017792:Surgical Stapling / Q000009:adverse effects; D016055:Urinary Retention / Q000209:etiology