Emergency Hemorrhoidectomy for Treating Acute Hemorrhoidal Crisis: A Single Institute Experience

Purpose. We present our clinical outcomes following emergency hemorrhoidectomy for treating patients with an acute hemorrhoidal crisis and assess various risk factors associated with complications. Methods. Between January 2001 and December 2003, 40 consecutive patients presenting with acute hemorrhoidal crisis were enrolled in the study. Acute hemorrhoidal crisis was defined as painful fixed prolapse or strangulated prolapse leading to thrombosis, ulceration or gangrene. All underwent emergency semiclosed hemorrhoidectomy under local anesthesia with conscious sedation within 12 h of admission. Patients were evaluated for clinical symptoms, operative data, perioperative pain, analgesic use, disability and complications. Results. The patients (29 men and 11 women) had a mean age of 40.3 years. The mean time between onset of prolapsed hemorrhoids and hospital admission was 34.4 hours. Thirteen patients (33%) had anemia. The mean duration of postoperative hospital stay was 2.8 days and the mean interval to resume normal activity was 10.6 days. There were no recurrent hemorrhoids with a mean follow-up of 15 months. Fever (18%) and urinary retention (10%) were the most common early complications. Anal stenosis developed in two patients (5%), and one of them needed further surgical intervention. No serious complications were recorded in this series. Increased age was identified as a factor with significantly elevated risk of late complications (OR: 1.07, 95% CI: 1.01-1.14). We also found about a twofold increased risk of early and late complications for the patients with anemia, although this was not significant. Conclusion. Emergency hemorrhoidectomy in the treating of patients with an acute hemorrhoidal crisis is safe and suitable. The complications are minor and acceptable. However, we should pay attention to older patients receiving emergency hemorrhoidectomy, as they require outpatient follow-up more frequently.