Hemorrhoid surgery outcome marred by long-term pain
MedWire News: Long-term anal pain is the most common complaint among patients who undergo hemorrhoid surgery, French researchers report in Colorectal Disease.
The team from Rennes University Hospital, led by Laurent Siproudhis, examined causes of patient dissatisfaction and physical symptoms in 359 patients who underwent Milligan-Morgan hemorrhoidectomy (n=205) or stapled hemorrhoidopexy (n=154) between 1998 and 2007. The patients, 198 of whom were male, were followed up for a median of 59 months after surgery.
The patients were sent a questionnaire in May 2008 detailing overall satisfaction with their procedure, residual hemorrhoid symptoms, irritable bowel syndrome (IBS), continence, and constipation.
Overall, 72% of the patients returned the questionnaire, with half of the patients highly satisfied with their surgery, and 33.0% satisfied. A further 13.6% were dissatisfied, and 2.4% had no opinion on the outcome.
Analysis showed that patients who were and were not satisfied with their treatment were similar in terms of age, parity, and history of hemorrhoid surgery or symptom duration. However, dissatisfied patients were more likely to be women (28 vs 87), to have IBS (8 vs 20), and to have experienced constipation for at least 10 years (10 vs 20).
Before surgery, patients who were dissatisfied with their treatment were significantly less likely than satisfied patients to have experienced bleeding (43 vs 63%) or anal prolapse (67 vs 84%), and significantly more likely to report anal pain (61 vs 45%) and internal procidentia or rectocele (27 vs 6%).
Although level of satisfaction was not significantly associated with type of hemorrhoid surgery, dissatisfied patients were more likely to have undergone additional procedures for tags, fissure, and rectocele than satisfied patients (36 vs 29%).
The rate of perioperative complications was not significantly linked to satisfaction, but dissatisfied patients took longer to heal than their satisfied counterparts (8.5 vs 6.0 weeks).
After surgery, dissatisfied patients were significantly more likely to report residual bleeding (48 vs 32%), anal prolapse (67 vs 31%), and anal pain (91 vs 55%), as well as incontinence (4 vs 1%) and constipation (19 vs 8%).
Dissatisfied patients were significantly more likely to seek care after surgery (78 vs 38%), and to require further treatment (79 vs 24%), including additional anal surgery (39 vs 2%).
"Self-perception of satisfaction after surgery for haemorrhoids may be associated with preoperative conditions (such as preoperative pain, sex, irritable bowel syndrome and a long past history of constipation) and functional postoperative complaints (pain and constipation) rather than the surgical procedure itself," Siproudhis et al summarize.
Noting that gender, IBS, constipation, anal pain, rectocele, and procidentia have not been previously grouped together as predictive factors for hemorrhoid surgery satisfaction, the team concludes "it is possible to speculate that, in some patients, haemorrhoidal disease might be a part of a more complex condition."
By Lynda Williams