Stratégie de prise en charge et de suivi au décours de l’hémorroïdectomie pédiculaire

Management strategy after haemorrhoidectomy: postoperative care and follow up

Résumé

Près d’un malade sur dix souffrant d’une maladie hémorroïdaire aura recours au traitement chirurgical pour soulager ses symptômes. En dépit de la diffusion large de l’hémorroïdopexie par agrafage circulaire selon Longo, l’hémorroïdectomie pédiculaire garde des indications privilégiées. Cette enquête, menée chez cinq équipes françaises expérimentées montre que la stratégie de prise en charge des malades hémorroïdectomisés apparaît relativement variable que ce soit en matière de prise en charge de la douleur, des soins postopératoires, de la durée d’hospitalisation ou de l’arrêt de travail. Un bon nombre des prescriptions des proctologues interrogés repose plus sur l’expérience personnelle que sur des données validées par des essais cliniques.

Abstract

About 10% of patients with haemorrhoids will need surgical treatment to relieve their symptoms. In spite of the development and large-scale use of the Longo procedure, the Milligan-Morgan haemorrhoidectomy is still indicated by preference for many cases. This study, carried out in five experienced French teams, shows that management after haemorrhoidectomy is relatively variable in terms of postoperative pain management, postoperative care, duration of hospital stay, and duration of incapacity to work. Many of the prescriptions issued by the surveyed proctologists are empirical, based on personal experience, rather than evidenced-based.

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Références

  1. 1.

    Bleday R, Pena JP, Rothenberger DA, et al. (1992) Symptomatic hemorrhoids: current incidence and complications of operative therapy. Dis Colon Rectum 35(5): 477–481

    PubMed  Article  CAS  Google Scholar 

  2. 2.

    Sutherland LM, Burchard AK, Matsuda K, et al. (2002) A systematic review of stapled hemorrhoidectomy. Arch Surg 137(12): 1395–1406; discussion 1407

    PubMed  Article  CAS  Google Scholar 

  3. 3.

    London NJ, Bramley PD, Windle R (1987) Effect of four days of preoperative lactulose on posthaemorrhoidectomy pain: results of placebo controlled trial. Br Med J (Clin Res Ed) 295(6594): 363–364

    CAS  Article  Google Scholar 

  4. 4.

    Abramowitz L, Godeberge P, Staumont G, et al. (2001) Recommandations pour la pratique clinique sur le traitement de la maladie hémorroïdaire. Gastroenterol Clin Biol 25: 674–702

    PubMed  CAS  Google Scholar 

  5. 5.

    Recommandations pour la pratique de l’antibioprophylaxie en chirurgie (1999) In: SFAR, Actualisation des recommandations issues de la conférence de consensus de Décembre 1992

  6. 6.

    Peters CJ, Botterill I, Ambrose NS, et al. (2005) Ligasure trademark vs conventional diathermy haemorrhoidectomy: long-term follow-up of a randomised clinical trial. Colorectal Dis 7(4): 350–353

    PubMed  Article  CAS  Google Scholar 

  7. 7.

    Vinson-Bonnet B, Coltat JC, Fingerhut A, et al. (2002) Local infiltration with ropivacaine improves immediate postoperative pain control after hemorrhoidal surgery. Dis Colon Rectum 45(1): 104–108

    PubMed  Article  Google Scholar 

  8. 8.

    Prise en charge de la douleur postopératoire chez l’adulte et l’enfant (1998) In: Elsevier (ed.), Recommandations de la Société française d’anesthésie réanimation. Paris p 445–461

  9. 9.

    Carapeti EA, Kamm MA, McDonald PJ, et al. (1998) Double-blind randomised controlled trial of effect of metronidazole on pain after day-case haemorrhoidectomy. Lancet 351(9097): 169–172

    PubMed  Article  CAS  Google Scholar 

  10. 10.

    Balfour L, Stojkovic SG, Botterill ID, et al. (2002) A randomized, double-blind trial of the effect of metronidazole on pain after closed hemorrhoidectomy. Dis Colon Rectum 45(9): 1186–1190; discussion 1190–1

    PubMed  Article  Google Scholar 

  11. 11.

    Nicholson TJ, Armstrong D (2004) Topical metronidazole (10 percent) decreases posthemorrhoidectomy pain and improves healing. Dis Colon Rectum 47(5): 711–716

    PubMed  Article  Google Scholar 

  12. 12.

    Hwang do Y, Yoon SG, Kim HS, et al. (2003) Effect of 0.2 percent glyceryl trinitrate ointment on wound healing after a hemorrhoidectomy: results of a randomized, prospective, double-blind, placebo-controlled trial. Dis Colon Rectum 46(7): 950–954

    PubMed  Article  Google Scholar 

  13. 13.

    Silverman R, Bendick PJ, Wasvary HJ (2005) A randomized, prospective, double-blind, placebo-controlled trial of the effect of a calcium channel blocker ointment on pain after hemorrhoidectomy. Dis Colon Rectum 48(10): 1913–1916

    PubMed  Article  Google Scholar 

  14. 14.

    Davies J, Duffy D, Boyt N, et al. (2003) Botulinum toxin (botox) reduces pain after hemorrhoidectomy: results of a double-blind, randomized study. Dis Colon Rectum 46(8): 1097–1102

    PubMed  Article  Google Scholar 

  15. 15.

    Patti R, Almasio PL, Muggeo VM, et al. (2005) Improvement of wound healing after hemorrhoidectomy: a double-blind, randomized study of botulinum toxin injection. Dis Colon Rectum 48(12): 2173–2179

    PubMed  Article  Google Scholar 

  16. 16.

    La Torre F, Nicolai AP (2004) Clinical use of micronized purified flavonoid fraction for treatment of symptoms after hemorrhoidectomy: results of a randomized, controlled, clinical trial. Dis Colon Rectum 47(5): 704–710

    PubMed  Article  Google Scholar 

  17. 17.

    Asfar SK, Juma TH, Ala-Edeen T (1988) Hemorrhoidectomy and sphincterotomy. A prospective study comparing the effectiveness of anal stretch and sphincterotomy in reducing pain after hemorrhoidectomy. Dis Colon Rectum 31(3): 181–185

    PubMed  Article  CAS  Google Scholar 

  18. 18.

    Mathai V, Ong BC, Ho YH (1996) Randomized controlled trial of lateral internal sphincterotomy with haemorrhoidectomy. Br J Surg 83(3): 380–382

    PubMed  Article  CAS  Google Scholar 

  19. 19.

    Khubchandani IT (2002) Internal sphincterotomy with hemorrhoidectomy does not relieve pain: a prospective, randomized study. Dis Colon Rectum 45(11): 1452–1457

    PubMed  Article  Google Scholar 

  20. 20.

    Seow-Choen F, Ho YH, Ang HG, et al. (1992) Prospective, randomized trial comparing pain and clinical function after conventional scissors excision/ligation vs diathermy excision without ligation for symptomatic prolapsed hemorrhoids. Dis Colon Rectum 35(12): 1165–1169

    PubMed  Article  CAS  Google Scholar 

  21. 21.

    Zaheer S, Reilly WT, Pemberton JH, et al. (1998) Urinary retention after operations for benign anorectal diseases. Dis Colon Rectum 41(6): 696–704

    PubMed  Article  CAS  Google Scholar 

  22. 22.

    Sielezneff I, Salle E, Lecuyer J, et al. (1997) Early postoperative morbidity after hemorrhoidectomy using the Milligan-Morgan technic. A retrospective studies of 1,134 cases. J Chir (Paris) 134(5–6): 243–247

    CAS  Google Scholar 

  23. 23.

    Pompeius R (1966) Detrusor inhibition induced from anal region in man. Acta Chir Scand Suppl 361: 1–54

    PubMed  CAS  Google Scholar 

  24. 24.

    Barone JG, Cummings KB (1994) Etiology of acute urinary retention following benign anorectal surgery. Am Surg 60(3): 210–211

    PubMed  CAS  Google Scholar 

  25. 25.

    Petros JG, Bradley TM (1990) Factors influencing postoperative urinary retention in patients undergoing surgery for benign anorectal disease. Am J Surg 159(4): 374–376

    PubMed  Article  CAS  Google Scholar 

  26. 26.

    Toyonaga T, Matsushima M, Sogawa N, et al. (2006) Postoperative urinary retention after surgery for benign anorectal disease: potential risk factors and strategy for prevention. Int J Colorectal Dis

  27. 27.

    Suduca P, Lemozy J, Garrigues JM, et al. (1980) Complications et séquelles de l’hémorroïdectomie. Étude multicentrique sur ordinateur d’une série de 1000 cas. Ann Gastroenterol Hepatol 16: 199–211

    Google Scholar 

  28. 28.

    Burger DH, Kappetein AP, Boutkan H, et al. (1997) Prevention of urinary retention after general surgery: a controlled trial of carbachol/diazepam versus alfusozine. J Am Coll Surg 185(3): 234–236

    PubMed  CAS  Google Scholar 

  29. 29.

    Gottesman L, Milsom JW, Mazier WP (1989) The use of anxiolytic and parasympathomimetic agents in the treatment of postoperative urinary retention following anorectal surgery. A prospective, randomized, double-blind study. Dis Colon Rectum 32(10): 867–870

    PubMed  Article  CAS  Google Scholar 

  30. 30.

    Myles LM, Aitken RJ, Griffiths JM (1994) Simple nonadherent dressing vs gelatin foam sponge plug after haemorrhoidectomy: a prospective randomized trial. Br J Surg 81(9): 1385

    PubMed  Article  CAS  Google Scholar 

  31. 31.

    Winter GD, Scales JT (1963) Effect of air drying and dressings on the surface of a wound. Nature 197: 91–92

    PubMed  Article  CAS  Google Scholar 

  32. 32.

    Hinman CD, Maibach H (1963) Effect of Air Exposure and Occlusion on Experimental Human Skin Wounds. Nature 200: 377–378

    PubMed  Article  CAS  Google Scholar 

  33. 33.

    Damour O, Hua SZ, Lasne F, et al. (1992) Cytotoxicity evaluation of antiseptics and antibiotics on cultured human fibroblasts and keratinocytes. Burns 18(6): 479–485

    PubMed  Article  CAS  Google Scholar 

  34. 34.

    Hansson C, Faergemann J (1995) The effect of antiseptic solutions on micro-organisms in venous leg ulcers. Acta Derm Venereol 75(1): 31–33

    PubMed  CAS  Google Scholar 

  35. 35.

    Denis J, Dubois N, Ganansia R, et al. (1989) Hemorroidectomy: hospital Leopold Bellan procedure. Int Surg 74: 152–153

    PubMed  CAS  Google Scholar 

  36. 36.

    Thein N, Moller P, Amtoft H, et al. (2000) A strong genotoxic effect in mouse skin of a single painting of coal tar in hairless mice and in MutaMouse. Mutat Res 468(2): 117–124

    PubMed  CAS  Google Scholar 

  37. 37.

    Pion IA, Koenig KL, Lim HW (1995) Is dermatologic usage of coal tar carcinogenic? A review of the literature. Dermatol Surg 21(3): 227–231

    PubMed  Article  CAS  Google Scholar 

  38. 38.

    Hunt L, Luck AJ, Rudkin G, et al. (1999) Day-case haemorrhoidectomy. Br J Surg 86(2): 255–258

    PubMed  Article  CAS  Google Scholar 

  39. 39.

    Kairaluoma M, Nuorva K, Kellokumpu I (2003) Daycase stapled (circular) vs diathermy hemorrhoidectomy: a randomized, controlled trial evaluating surgical and functional outcome. Dis Colon Rectum 46(1): 93–99

    PubMed  Article  Google Scholar 

  40. 40.

    Ho YH, Lee J, Salleh I, et al. (1998) Randomized controlled trial comparing same-day discharge with hospital stay following haemorrhoidectomy. Aust N Z J Surg 68(5): 334–336

    PubMed  CAS  Google Scholar 

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Correspondence to A. Sénéjoux.

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Sénéjoux, A. Stratégie de prise en charge et de suivi au décours de l’hémorroïdectomie pédiculaire. Côlon Rectum 1, 47–52 (2007). https://doi.org/10.1007/s11725-006-0015-7

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Mots clés

  • Hémorroïdes
  • Hémorroïdectomie
  • Soins postopératoires
  • Douleur postopératoire

Keywords

  • Haemorrhoids
  • Haemorrhoidectomy
  • Postoperative care
  • Postoperative pain