Hemorrhoidectomy Complication
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Regardless of the excisional technique employed for the treatment of advanced hemorrhoids, the key to effective patient management is avoiding postoperative complications. Pain is by far the most frequent complication and probably the most feared sequela with the procedure from the patient’s perspective. Many different analgesic regimens have been recommended, commonly consisting of a combination of oral and parenteral narcotics.Using local infiltration of bupivicaine into the wounds and perianal skin has been variably productive in long-term pain reduction.Conversely, ketorolac has demonstrated considerable efficacy inside management of posthemorrhoidectomy pain.Using alternative administration routes for narcotics by either patch or subcutaneous pump has been profitable in controlling pain, but the management of these routes of administration could be risky from the outpatient setting because with the risk of narcotic-induced respiratory depression. Essentially the most appropriate regimen following outpatient hemorrhoidectomy appears to become the intraoperative use of ketorolac, sufficient doses of oral narcotic analgesics for home administration, and supplementation of the narcotics with oral nonsteroidal medication.
Urinary retention is a frequent postoperative difficulty right after hemorrhoidectomy, ranging in incidence from 1 to 52%. A range of strategies have been used to treat the trouble, including parasympathomimetics, alpha-adrenergic-blocking agents, and sitz baths.The greatest method, nevertheless, seems to be prevention that includes limiting perioperative fluid administration to 250 ml, an anesthetic strategy that avoids using spinal anesthesia, the avoidance of anal packing, and an aggressive oral analgesic regimen.
Early postoperative bleeding (<24 hours) occurs in approximately 1% of patients and represents a technical error that requires return to the operating room for resuturing of the offending wound.Delayed hemorrhage occurs in 0.5 to 4% of cases of excisional hemorrhoidectomy at 5 to 10 days postoperatively.The cause is likely early separation of the ligated pedicle before adequate thrombosis from the feeding artery can occur.In this scenario, the bleeding is typically significant and requires some method for the control of ongoing hemorrhage. Options include return to the operating room for suture ligation or tamponade at the bedside with Foley catheter or anal packing. The subsequent outcome after the control of secondary hemorrhage is generally good with virtually no risk of recurrent bleeding. It may be helpful to irrigate the distal colorectum with posthemorrhage enemas or at the time of intraoperative control of bleeding to avoid confusion when the residual clots pass per anum.
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