Postoperative Complications Following Surgical Procedures for Hemorrhoids and Their Management
Minor complications following surgical procedures for hemorrhoidal disease are quite common and include pain, rectal bleeding, vasovagal reaction, micturition disturbances, anal fissures, and ulcers in the anal canal. Analgesics of the NSAID group and others are used to treat mild pain. Observation and/or surgical hemostasis are relevant in case of minor rectal bleeding. Micturition disturbances should be monitored with bladder scans and catheterization if necessary.
Massive rectal bleeding, severe pain, urinary retention, pelvic sepsis, and even death are considered as major complications. They are uncommon with an estimate between 1% and 2.5%.
Severe rectal bleeding is usually treated with surgical hemostasis and blood transfusions. The septic complication is the most feared complication with a significant risk of major morbidity and even of death. It may be in progress if a patient presents with unexpected severe perianal/abdominal pain in combination with urinary retention and fever. Objective findings may be sparse, and it is not uncommon that the patient has attended the hospital more than once before the condition is recognized. Cases presenting early with tissue edema and sepsis in the absence of necrosis may be treated only with antibiotics and supportive care. In the presence of necrosis, debridement should be undertaken urgently with or without laparotomy and fecal diversion in addition to antibiotics and supportive care.
Early recognition and immediate treatment of septic complications are crucial for a successful outcome.
- Blouhos K, Vasiliadis K, Tsalis K, Botsios D, Vrakas X (2007) Uncontrollable intra-abdominal bleeding necessitating low anterior resection of the rectum after stapled hemorrhoidopexy: report of a case. Surg Today 37(3):254–257. https://doi.org/10.1007/s00595-006-3363-xCrossRefPubMedPubMedCentralGoogle Scholar
- Brown SR, Tiernan JP, Watson AJ, Biggs K, Shephard N, Wailoo AJ, Bradburn M, Alshreef A, Hind D, Hub BS (2016) Haemorrhoidal artery ligation versus rubber band ligation for the management of symptomatic second-degree and third-degree haemorrhoids (HubBLe): a multicentre, open-label, randomised controlled trial. Lancet 388(10042):356–364. https://doi.org/10.1016/S0140-6736(16)30584-0CrossRefPubMedPubMedCentralGoogle Scholar
- Giamundo P, Cecchetti W, Esercizio L, Fantino G, Geraci M, Lombezzi R, Pittaluga M, Tibaldi L, Torre G, Valente M (2011a) Doppler-guided hemorrhoidal laser procedure for the treatment of symptomatic hemorrhoids: experimental background and short-term clinical results of a new mini-invasive treatment. Surg Endosc 25(5):1369–1375. https://doi.org/10.1007/s00464-010-1370-xCrossRefPubMedPubMedCentralGoogle Scholar
- Giamundo P, Salfi R, Geraci M, Tibaldi L, Murru L, Valente M (2011b) The hemorrhoid laser procedure technique vs rubber band ligation: a randomized trial comparing 2 mini-invasive treatments for second- and third-degree hemorrhoids. Dis Colon Rectum 54(6):693–698. https://doi.org/10.1007/DCR.0b013e3182112d58CrossRefPubMedPubMedCentralGoogle Scholar
- Goligher J (1984) Surgery of the anus, rectum and colon, 5th edn. Baillière’s Tindal, LondonGoogle Scholar
- Jongen J, Bach S, Stubinger SH, Bock JU (2003) Excision of thrombosed external hemorrhoid under local anesthesia: a retrospective evaluation of 340 patients. Dis Colon Rectum 46(9):1226–1231. https://doi.org/10.1097/01.DCR.0000081171.18194.51CrossRefPubMedGoogle Scholar
- Kam MH, Ng KH, Lim JF, Ho KS, Ooi BS, Tang CL, Eu KW (2011) Results of 7302 stapled haemorrhoidectomy operations in a single centre: a seven-year review and follow-up questionnaire survey. ANZ J Surg 81(4):253–256. https://doi.org/10.1111/j.1445-2197.2010.05478.xCrossRefPubMedPubMedCentralGoogle Scholar
- Marques CF, Nahas SC, Nahas CS, Sobrado CW Jr, Habr-Gama A, Kiss DR (2006) Early results of the treatment of internal hemorrhoid disease by infrared coagulation and elastic banding: a prospective randomized cross-over trial. Tech Coloproctol 10(4):312–317. https://doi.org/10.1007/s10151-006-0299-5CrossRefPubMedPubMedCentralGoogle Scholar
- Neiger A (1979) Haemorrhoids in everyday practice. Proctology 2:22–28Google Scholar
- Poulsen J, Vejlby A, Lind M (2014) [Fatal complication of haemorrhoidal banding]. Ugeskr Laeger 176 (25A)Google Scholar
- Ratto C, Donisi L, Parello A, Litta F, Zaccone G, De Simone V (2012) “Distal Doppler-guided dearterialization” is highly effective in treating haemorrhoids by transanal haemorrhoidal dearterialization. Colorectal Dis 14(11):e786–e789. https://doi.org/10.1111/j.1463-1318.2012.03146.xCrossRefPubMedGoogle Scholar
- Ratto C, Parello A, Veronese E, Cudazzo E, D'Agostino E, Pagano C, Cavazzoni E, Brugnano L, Litta F (2015) Doppler-guided transanal haemorrhoidal dearterialization for haemorrhoids: results from a multicentre trial. Colorectal Dis 17(1):O10–O19. https://doi.org/10.1111/codi.12779CrossRefPubMedGoogle Scholar
- Simillis C, Thoukididou SN, Slesser AA, Rasheed S, Tan E, Tekkis PP (2015) Systematic review and network meta-analysis comparing clinical outcomes and effectiveness of surgical treatments for haemorrhoids. Br J Surg 102(13):1603–1618. https://doi.org/10.1002/bjs.9913CrossRefPubMedPubMedCentralGoogle Scholar