Objective: Grade IV hemorrhoid is not uncommon in surgical practice. When making a decision to operate, the physician needs to estimate the size of the hemorrhoidal head to be cut and distinguish it from the surrounding anoderm remnant. The present study compared the results of operations performed in emergency situations (not later than 6 hours after admission) with those conducted in urgent scenarios (more than 6 hours subsequent to admission).

Materials and Methods: This retrospective study was conducted between January 2007 and December 2015. Inclusion criteria were patients who were diagnosed with grade IV hemorrhoid and underwent surgery and follow-up at Rajavithi Hospital. The exclusion criteria were patients who: (1) refused or were unfit for surgery; (2) were lost to follow-up; (3) had undergone other anal operations; (4) had underlying bowel disease such as Crohn’s disease, ulcerative colitis or anal cancer; and (5) were immunocompromised.

Results: A total 180 patients with grade IV hemorrhoid were included. Their average age was 43.93+12.68 years (16 to 82), their BMI was 23.45+2.82 kg/m2 (16.8 to 32.3), and their median time to presentation after onset of pain was 2 days (1 to 7 days). The average time to operation was 7.42+2.85 hours (1 to 24 hours), median number of hemorrhoid heads excised was 2 (1 to 5) and the average operative time was 69.56+19.19 (45 to 150) minutes. Comparative analysis between the emergency and urgent patients showed that patients in the latter group had fewer hemorrhoid head excisions, and that their operative time, intra-operative fluid and postoperative complications were statistically significantly lower than those in the emergency group.

Conclusion: Hemorrhoidectomy in grade IV hemorrhoid is safe and its outcomes are comparable to those of surgery performed in elective settings.

Keywords: Hemorrhoid, Grade IV, Hemorrhoidectomy, Emergency