A Comparison of Early Postoperative Results between Urgent Closed Hemorrhoidectomy for Prolapsed Thrombosed Hemorrhoids and Elective Closed Hemorrhoidectomy
Jirawat Pattana-arun MD*, Warin Wesarachawit MD*, Kasaya Tantiphlachiva MD*, Puttarat Atithansakul MD*, Chucheep Sahakitrungruang MD*, Arun Rojanasakul MD*
Affiliation : * Division of Colorectal Surgery, Department of Surgery, Chulalongkorn University, Bangkok, Thailand
Objective : To compare the perioperative complications, analgesics requirement, and length of hospital stay
between patients undergoing urgent closed hemorrhoidectomy for prolapsed thrombosed hemorrhoid and
elective closed hemorrhoidectomy.
Research design: Retrospective, comparative study
Material and Method: All records of the patients who underwent urgent and elective hemorrhoidectomy
between January 2000 and December 2005 were reviewed. Perioperative complications (bleeding, urinary
retention, post-operative thrombosis, and wound dehiscence), analgesic requirement, and length of hospital
stay were analyzed.
Statistics: Chi-Square Test and Mann-Whitney U Test.
Results : From 1,440 patients, 1,184 patients met the inclusion criteria. All were done with closed technique.
The indication for urgent hemorrhoidectomy was prolapsed thrombosed hemorrhoid in 416 patients (group 1).
The indication for elective hemorrhoidectomy were grade 3 and 4 internal hemorrhoid, external hemorrhoid
or combined hemorrhoid in 768 patients (group 2). There was no statistically significant difference in urinary
retention and bleeding complication between two groups; 31 patients (7.5%) in group 1 and 69 patients
(8.9%) in group 2 experienced urinary retention p = 0.426, five patients (1.2%) in group 1 and 10 patients
(1.3%) in group 2 had postoperative bleeding, p = 1.000). On the second postoperative week, wound
dehiscence was found in nine patients (2.2%) from group 1 and 15 patients (2%) from group 2. On the fourth
week, all the wounds were completely healed without granulation or stricture formation. Post-operative
meperidine requirement was significantly lower in the urgent hemorrhoidectomy group (0.84 + 0.71 vs. 0.99
+ 0.81 mg/kg, p < 0.001). Post-operative length of hospital stay were not statistically different (1.017 + 0.129
vs. 1.016 + 0.124, p = 0.107).
Conclusion : Urgent closed hemorrhoidectomy for prolapsed thrombosed hemorrhoids may be a preferable
option for patients suffering from this condition.
Keywords : Urgent hemorrhoidectomy, Prolapsed thrombosed hemorrhoid, Complications
