Hemorrhoids pp 461-470 | Cite as

Postoperative Complications Following Surgical Procedures for Hemorrhoids and Their Management

  • Steen BuntzenEmail author
Reference work entry
Part of the Coloproctology book series (COLOPROCT, volume 2)


Minor complications following surgical procedures for hemorrhoidal disease are quite common and include pain, rectal bleeding, vasovagal reaction, micturition disturbances, anal fissures, and ulcers in the anal canal. Analgesics of the NSAID group and others are used to treat mild pain. Observation and/or surgical hemostasis are relevant in case of minor rectal bleeding. Micturition disturbances should be monitored with bladder scans and catheterization if necessary.

Massive rectal bleeding, severe pain, urinary retention, pelvic sepsis, and even death are considered as major complications. They are uncommon with an estimate between 1% and 2.5%.

Severe rectal bleeding is usually treated with surgical hemostasis and blood transfusions. The septic complication is the most feared complication with a significant risk of major morbidity and even of death. It may be in progress if a patient presents with unexpected severe perianal/abdominal pain in combination with urinary retention and fever. Objective findings may be sparse, and it is not uncommon that the patient has attended the hospital more than once before the condition is recognized. Cases presenting early with tissue edema and sepsis in the absence of necrosis may be treated only with antibiotics and supportive care. In the presence of necrosis, debridement should be undertaken urgently with or without laparotomy and fecal diversion in addition to antibiotics and supportive care.

Early recognition and immediate treatment of septic complications are crucial for a successful outcome.


  1. Adami B, Eckardt VF, Suermann RB, Karbach U, Ewe K (1981) Bacteremia after proctoscopy and hemorrhoidal injection sclerotherapy. Dis Colon Rectum 24(5):373–374CrossRefPubMedGoogle Scholar
  2. Ahmad A, Kant R, Gupta A (2013) Comparative analysis of doppler guided hemorrhoidal artery ligation (DG-HAL) & infrared coagulation (IRC) in management of hemorrhoids. Indian J Surg 75(4):274–277. Scholar
  3. Albuquerque A (2016) Rubber band ligation of hemorrhoids: a guide for complications. World J Gastrointest Surg 8(9):614–620. Scholar
  4. Al-Ghnaniem R, Leather AJ, Rennie JA (2001) Survey of methods of treatment of haemorrhoids and complications of injection sclerotherapy. Ann R Coll Surg Engl 83(5):325–328PubMedPubMedCentralGoogle Scholar
  5. Anderson J, Steger A (1984) Fatal meningitis complicating cryosurgery for haemorrhoids. Br Med J (Clin Res Ed) 288(6420):826CrossRefGoogle Scholar
  6. Barron J (1963) Office ligation of internal hemorrhoids. Am J Surg 105:563–570CrossRefPubMedGoogle Scholar
  7. Barwell J, Watkins RM, Lloyd-Davies E, Wilkins DC (1999) Life-threatening retroperitoneal sepsis after hemorrhoid injection sclerotherapy: report of a case. Dis Colon Rectum 42(3):421–423CrossRefPubMedGoogle Scholar
  8. Bat L, Melzer E, Koler M, Dreznick Z, Shemesh E (1993) Complications of rubber band ligation of symptomatic internal hemorrhoids. Dis Colon Rectum 36(3):287–290CrossRefPubMedGoogle Scholar
  9. Berkel AE, Witte ME, Koop R, Hendrix MG, Klaase JM (2013) Brain abscess after transanal hemorrhoidal dearterialization: a case report. Case Rep Gastroenterol 7(2):208–213. Scholar
  10. Blouhos K, Vasiliadis K, Tsalis K, Botsios D, Vrakas X (2007) Uncontrollable intra-abdominal bleeding necessitating low anterior resection of the rectum after stapled hemorrhoidopexy: report of a case. Surg Today 37(3):254–257. Scholar
  11. Brown SR, Ballan K, Ho E, Ho Fams YH, Seow-Choen F (2001) Stapled mucosectomy for acute thrombosed circumferentially prolapsed piles: a prospective randomized comparison with conventional haemorrhoidectomy. Colorectal Dis 3(3):175–178CrossRefPubMedGoogle Scholar
  12. Brown SR, Tiernan JP, Watson AJ, Biggs K, Shephard N, Wailoo AJ, Bradburn M, Alshreef A, Hind D, Hub BS (2016) Haemorrhoidal artery ligation versus rubber band ligation for the management of symptomatic second-degree and third-degree haemorrhoids (HubBLe): a multicentre, open-label, randomised controlled trial. Lancet 388(10042):356–364. Scholar
  13. Bullock N (1997) Impotence after sclerotherapy of haemorrhoids: case reports. BMJ 314(7078):419CrossRefPubMedPubMedCentralGoogle Scholar
  14. Ceulemans R, Creve U, Van Hee R, Martens C, Wuyts FL (2000) Benefit of emergency haemorrhoidectomy: a comparison with results after elective operations. Eur J Surg 166(10):808–812; discussion 813. Scholar
  15. Cheng FC, Shum DW, Ong GB (1981) The treatment of second degree haemorrhoids by injection, rubber band ligation, maximal anal dilatation, and haemorrhoidectomy: a prospective clinical trial. Aust N Z J Surg 51(5):458–462CrossRefPubMedGoogle Scholar
  16. Crea N, Pata G, Lippa M, Chiesa D, Gregorini ME, Gandolfi P (2014) Hemorrhoidal laser procedure: short- and long-term results from a prospective study. Am J Surg 208(1):21–25. Scholar
  17. Eu KW, Seow-Choen F, Goh HS (1994) Comparison of emergency and elective haemorrhoidectomy. Br J Surg 81(2):308–310CrossRefPubMedGoogle Scholar
  18. Filingeri V, Angelico R, Bellini MI, Manuelli M, Sforza D (2013) Ambulatory therapy with combined hemorrhoidal radiocoagulation. Eur Rev Med Pharmacol Sci 17(1):130–133PubMedGoogle Scholar
  19. Gartell PC, Sheridan RJ, McGinn FP (1985) Out-patient treatment of haemorrhoids: a randomized clinical trial to compare rubber band ligation with phenol injection. Br J Surg 72(6):478–479CrossRefPubMedGoogle Scholar
  20. Giamundo P, Cecchetti W, Esercizio L, Fantino G, Geraci M, Lombezzi R, Pittaluga M, Tibaldi L, Torre G, Valente M (2011a) Doppler-guided hemorrhoidal laser procedure for the treatment of symptomatic hemorrhoids: experimental background and short-term clinical results of a new mini-invasive treatment. Surg Endosc 25(5):1369–1375. Scholar
  21. Giamundo P, Salfi R, Geraci M, Tibaldi L, Murru L, Valente M (2011b) The hemorrhoid laser procedure technique vs rubber band ligation: a randomized trial comparing 2 mini-invasive treatments for second- and third-degree hemorrhoids. Dis Colon Rectum 54(6):693–698. Scholar
  22. Giordano P, Overton J, Madeddu F, Zaman S, Gravante G (2009) Transanal hemorrhoidal dearterialization: a systematic review. Dis Colon Rectum 52(9):1665–1671. Scholar
  23. Goligher J (1984) Surgery of the anus, rectum and colon, 5th edn. Baillière’s Tindal, LondonGoogle Scholar
  24. Gupta PJ (2002) Radiofrequency coagulation: an alternative treatment in early grade bleeding hemorrhoids. Tech Coloproctol 6(3):203–204CrossRefPubMedGoogle Scholar
  25. Gupta PJ (2005) Ambulatory hemorrhoid therapy with radiofrequency coagulation. Clinical practice paper. Rom J Gastroenterol 14(1):37–41PubMedPubMedCentralGoogle Scholar
  26. Hardy A, Cohen CR (2014) The acute management of haemorrhoids. Ann R Coll Surg Engl 96(7):508–511. Scholar
  27. Iyer VS, Shrier I, Gordon PH (2004) Long-term outcome of rubber band ligation for symptomatic primary and recurrent internal hemorrhoids. Dis Colon Rectum 47(8):1364–1370CrossRefPubMedGoogle Scholar
  28. Johannsson HO, Graf W, Pahlman L (2002) Long-term results of haemorrhoidectomy. Eur J Surg 168(8–9):485–489. Scholar
  29. Jongen J, Bach S, Stubinger SH, Bock JU (2003) Excision of thrombosed external hemorrhoid under local anesthesia: a retrospective evaluation of 340 patients. Dis Colon Rectum 46(9):1226–1231. Scholar
  30. Kam MH, Ng KH, Lim JF, Ho KS, Ooi BS, Tang CL, Eu KW (2011) Results of 7302 stapled haemorrhoidectomy operations in a single centre: a seven-year review and follow-up questionnaire survey. ANZ J Surg 81(4):253–256. Scholar
  31. Kaman L, Aggarwal S, Kumar R, Behera A, Katariya RN (1999) Necrotizing fascitis after injection sclerotherapy for hemorrhoids: report of a case. Dis Colon Rectum 42(3):419–420CrossRefPubMedGoogle Scholar
  32. Komborozos VA, Skrekas GJ, Pissiotis CA (2000) Rubber band ligation of symptomatic internal hemorrhoids: results of 500 cases. Dig Surg 17(1):71–76. Scholar
  33. Lewis MI, De la Cruz T, Gazzaniga DA, Ball TL (1969) Cryosurgical hemorrhoidectomy: preliminary report. Dis Colon Rectum 12(5):371–378CrossRefPubMedGoogle Scholar
  34. MacRae HM, McLeod RS (1995) Comparison of hemorrhoidal treatment modalities. A meta-analysis. Dis Colon Rectum 38(7):687–694CrossRefPubMedGoogle Scholar
  35. Marques CF, Nahas SC, Nahas CS, Sobrado CW Jr, Habr-Gama A, Kiss DR (2006) Early results of the treatment of internal hemorrhoid disease by infrared coagulation and elastic banding: a prospective randomized cross-over trial. Tech Coloproctol 10(4):312–317. Scholar
  36. Marshman D, Huber PJ Jr, Timmerman W, Simonton CT, Odom FC, Kaplan ER (1989) Hemorrhoidal ligation. A review of efficacy. Dis Colon Rectum 32(5):369–371CrossRefPubMedGoogle Scholar
  37. McCloud JM, Jameson JS, Scott AN (2006) Life-threatening sepsis following treatment for haemorrhoids: a systematic review. Colorectal Dis 8(9):748–755. Scholar
  38. Morinaga K, Hasuda K, Ikeda T (1995) A novel therapy for internal hemorrhoids: ligation of the hemorrhoidal artery with a newly devised instrument (Moricorn) in conjunction with a Doppler flowmeter. Am J Gastroenterol 90(4):610–613PubMedPubMedCentralGoogle Scholar
  39. Neiger A (1979) Haemorrhoids in everyday practice. Proctology 2:22–28Google Scholar
  40. Ng KH, Ho KS, Ooi BS, Tang CL, Eu KW (2006) Experience of 3711 stapled haemorrhoidectomy operations. Br J Surg 93(2):226–230. Scholar
  41. Porrett LJ, Porrett JK, Ho YH (2015) Documented complications of staple hemorrhoidopexy: a systematic review. Int Surg 100(1):44–57. Scholar
  42. Poulsen J, Vejlby A, Lind M (2014) [Fatal complication of haemorrhoidal banding]. Ugeskr Laeger 176 (25A)Google Scholar
  43. Pucher PH, Sodergren MH, Lord AC, Darzi A, Ziprin P (2013) Clinical outcome following Doppler-guided haemorrhoidal artery ligation: a systematic review. Colorectal Dis 15(6):e284–e294. Scholar
  44. Ratto C, Donisi L, Parello A, Litta F, Zaccone G, De Simone V (2012) “Distal Doppler-guided dearterialization” is highly effective in treating haemorrhoids by transanal haemorrhoidal dearterialization. Colorectal Dis 14(11):e786–e789. Scholar
  45. Ratto C, Parello A, Veronese E, Cudazzo E, D'Agostino E, Pagano C, Cavazzoni E, Brugnano L, Litta F (2015) Doppler-guided transanal haemorrhoidal dearterialization for haemorrhoids: results from a multicentre trial. Colorectal Dis 17(1):O10–O19. Scholar
  46. Ribbans WJ, Radcliffe AG (1985) Retroperitoneal abscess following sclerotherapy for hemorrhoids. Dis Colon Rectum 28(3):188–189CrossRefPubMedGoogle Scholar
  47. Ricci MP, Matos D, Saad SS (2008) Rubber band ligation and infrared photocoagulation for the outpatient treatment of hemorrhoidal disease. Acta Cir Bras 23(1):102–106CrossRefPubMedGoogle Scholar
  48. Sayfan J (2001) Complications of Milligan-Morgan hemorrhoidectomy. Dig Surg 18(2):131–133. Scholar
  49. Schulte T, Fandrich F, Kahlke V (2008) Life-threatening rectal necrosis after injection sclerotherapy for haemorrhoids. Int J Color Dis 23(7):725–726. Scholar
  50. Sim AJ, Murie JA, Mackenzie I (1981) Comparison of rubber band ligation and sclerosant injection for first and second degree haemorrhoids– a prospective clinical trial. Acta Chir Scand 147(8):717–720PubMedPubMedCentralGoogle Scholar
  51. Simillis C, Thoukididou SN, Slesser AA, Rasheed S, Tan E, Tekkis PP (2015) Systematic review and network meta-analysis comparing clinical outcomes and effectiveness of surgical treatments for haemorrhoids. Br J Surg 102(13):1603–1618. Scholar
  52. Templeton JL, Spence RA, Kennedy TL, Parks TG, Mackenzie G, Hanna WA (1983) Comparison of infrared coagulation and rubber band ligation for first and second degree haemorrhoids: a randomised prospective clinical trial. Br Med J (Clin Res Ed) 286(6375):1387–1389CrossRefGoogle Scholar
  53. Walker AJ, Leicester RJ, Nicholls RJ, Mann CV (1990) A prospective study of infrared coagulation, injection and rubber band ligation in the treatment of haemorrhoids. Int J Color Dis 5(2):113–116CrossRefGoogle Scholar
  54. Watson NF, Liptrott S, Maxwell-Armstrong CA (2006) A prospective audit of early pain and patient satisfaction following out-patient band ligation of haemorrhoids. Ann R Coll Surg Engl 88(3):275–279. Scholar
  55. Wright AD (1950) Complications of rectal injections. Proc R Soc Med 43(4):263–266PubMedPubMedCentralGoogle Scholar
  56. Yamamoto Y, Sano K (1982) Cryosurgical hemorrhoidectomy: how to prevent the postoperative swelling and prolapse. Cryobiology 19(3):289–291CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Gastrointestinal Surgery, University Hospital of North Norway and The National Advisory Board of Incontinence and Pelvic Floor Health of NorwayThe Arctic University of NorwayTromsøNorway

Personalised recommendations