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Ambulatory haemorrhoidal surgery: systematic literature review and qualitative analysis

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Abstract

Purpose

The aims of this study are to review the advantages and drawbacks of the ambulatory management of patients scheduled for haemorrhoidal surgery and to highlight the reasons for unplanned hospital admission and suggest preventive strategies.

Methods

We conducted a systematic review of the literature from January 1999 to January 2013 using MEDLINE and EMBASE databases. Manuscripts were specifically analysed for failure and side effects of haemorrhoidal surgery in ambulatory settings.

Results

Fifty relevant studies (6082 patients) were retrieved from the literature review. The rate of ambulatory management failure ranged between 0 and 61 %. The main reasons for failure were urinary retention, postoperative haemorrhage and unsatisfactory pain control. Spinal anaesthesia was associated with the highest rates of urinary retention. Doppler-guided haemorrhoidal artery ligation has less frequent side effects susceptible to impair ambulatory management than haemorrhoidectomy and stapled haemorrhoidopexy. However, the fact that haemorrhoidopexy is less painful than haemorrhoidectomy may allow ambulatory management.

Conclusion

Day-case haemorrhoidal surgery can be performed whatever the surgical procedure. Postoperative pain deserves special prevention measures after haemorrhoidectomy, especially by using perineal block or infiltrations. Urinary retention is a common issue that can be responsible for failure; it requires a preventive strategy including short duration spinal anaesthesia. Doppler-guided haemorrhoidal artery ligation is easy to perform in outpatients but deserves more complete evaluation in this setting.

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Acknowledgments

We thank Dr. Alison Foote (Grenoble Clinical Research Centre) for the language editing.

Conflict of interest

The authors have no conflicts of interest to declare.

Source of funding

There was no specific funding for this review.

Contributions

BVB and TH conducted the literature search and analysed the retrieved articles. BVB wrote the manuscript which was reviewed and edited by all the other authors (BVB, TH, JLF, LS) who also participated in defining the methodology of the review.

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Authors and Affiliations

  1. Department of Visceral and Ambulatory Surgery, Centre Hospitalier Intercommunal de Poissy Saint Germain en Laye, 10 rue du champ Gaillard, BP 73082, 78303, Poissy cedex, France

    B. Vinson-Bonnet

  2. Department of Gastroenterology, Clinique Beausoleil, 06240, Beausoleil, France

    T. Higuero

  3. Department of Colorectal Surgery, Grenoble University Hospital, Université Grenoble Alpes, CS 10217, 38043, Grenoble, France

    J. L. Faucheron

  4. Department of Gastroenterology, Centre Hospitalier privé Saint-Grégoire, 35760, Saint-Grégoire, France

    A. Senejoux

  5. Service de Proctologie, Hôpital Bagatelle, Talence, France

    F. Pigot

  6. Unité fonctionnelle de proctologie, pôle abdomen, CHU Pontchaillou, 2 rue Henri-Le-Guilloux, Rennes cedex 9, France

    L. Siproudhis

Authors
  1. B. Vinson-Bonnet
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  2. T. Higuero
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  3. J. L. Faucheron
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  4. A. Senejoux
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  5. F. Pigot
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  6. L. Siproudhis
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Corresponding author

Correspondence to B. Vinson-Bonnet.

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Vinson-Bonnet, B., Higuero, T., Faucheron, J.L. et al. Ambulatory haemorrhoidal surgery: systematic literature review and qualitative analysis. Int J Colorectal Dis 30, 437–445 (2015). https://doi.org/10.1007/s00384-014-2073-x

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