Post-hemorrhoidectomy Secondary Hemorrhage

Choi, Dong Ha

Abstract

PURPOSE: Post-hemorrhoidectomy secondary hemorrhage is a rare but serious complication after a hemorrhoidectomy. This study analyzed the factors associated with secondary hemorrhage following a surgical hemorrhoidectomy.
METHODS
A total of 1,751 patients received a semiclosed hemorrhoidectomy for symptomatic hemorrhoidal disease from May 2001 to January 2004. A retrospective study of 17 patients with post-hemorrhoidectomy secondary hemorrhage was done. Fourteen patients (82 percent) underwent surgery primarily for hemorrhoidal disease, two patients (12 percent) had hemorrhoids removed in addition to a sphincterotomy for anal fissure, and the remaining patient (6 percent) had a hemorrhoidectomy with fistulectomy. The variables analyzed included age, gender, incidence, recurrence, hospitalization, bleeding tendency, blood transfusion, and management.
RESULTS
The male to female ratio was 1.83:1 (P>0.05), and the mean age was 38.9 (range 19~55) years. The incidence of post-hemorrhoidectomy secondary hemorrhage was 0.98 percent. The mean interval from the operation to hemorrhage was 8.9 (range 4~18) days. The period of mean hospitalization was 4.5 (range 2~8) days. As predisposing factors, 3 patients had suspected liver disease with normal platelet count. The mean 1.90 gm/dl of Hgb at the time of secondary hemorrhage was lower than the preoperative values. One patient (5.9 percent) required 3 units of red blood cell transfusions. Treatment modalities included observation alone in three patients (18 percent), and suture ligation in the operating theater in fourteen patients (82 percent). None of the patients developed recurrent bleeding.
CONCLUSIONS
Post-hemorrhoidectomy secondary hemorrhage is an inevitable and a troublesome complication. The patient will need to be transferred rapidly to a hospital and resuscitated if necessary. The author favors suture ligation in controlling secondary hemorrhage. Suture ligation offers a good outcome with virtually no risk of recurrent bleeding. Post- hemorrhoidectomy secondary hemorrhage usually occurs at home between the fourth and eighteenth postoperative day and takes place in 0.98 percent of hemorrhoidectomies. In the author's opinion, post-hemorrhoidectomy secondary hemorrhage usually is not a preventable complication.