Retrospective Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jan 16, 2023; 11(2): 366-384
Published online Jan 16, 2023. doi: 10.12998/wjcc.v11.i2.366
Ten-year multicentric retrospective analysis regarding postoperative complications and impact of comorbidities in hemorrhoidal surgery with literature review
Cosmin Moldovan, Elena Rusu, Daniel Cochior, Madalina Elena Toba, Horia Mocanu, Razvan Adam, Mirela Rimbu, Adrian Ghenea, Florin Savulescu, Daniela Godoroja, Florin Botea
Cosmin Moldovan, Daniel Cochior, Madalina Elena Toba, Horia Mocanu, Razvan Adam, Florin Savulescu, Florin Botea, Department of Medical Surgical Disciplines, Faculty of Medicine, Titu Maiorescu University of Bucharest, Bucharest 031593, Romania
Cosmin Moldovan, Madalina Elena Toba, Department of General Surgery, Witting Clinical Hospital, Bucharest 010243, Romania
Elena Rusu, Department of Preclinic Disciplines, Faculty of Medicine, Titu Maiorescu University of Bucharest, Bucharest 031593, Romania
Daniel Cochior, Department of General Surgery, Sanador Clinical Hospital, Bucharest 010991, Romania
Daniel Cochior, Department of General Surgery, Monza Clinical Hospital, Bucharest 021967, Romania
Horia Mocanu, Department of Ear, Nose and Throat, Ilfov County Clinical Emergency Hospital, Bucharest 022104, Romania
Razvan Adam, Department of Orthopedics and Traumatology, Elias Emergency University Hospital, Bucharest 011461, Romania
Mirela Rimbu, Medical Doctoral School, Titu Maiorescu University of Bucharest, Bucharest 040317, Romania
Adrian Ghenea, Department of Coloproctology, MedLife SA Băneasa Hyperclinic, Bucharest 013693, Romania
Florin Savulescu, 2nd Department of Surgery, Carol Davila Central Military Emergency University Hospital, Bucharest 010242, Romania
Daniela Godoroja, Department of Anesthesia, Ponderas Academic Hospital, Bucharest 014142, Romania
Florin Botea, 2nd Department of Surgery, Fundeni Clinical Institute, Bucharest 022328, Romania
Author contributions: Moldovan C provided conceptualization; Rusu E, Tobă M, Mocanu H, Adam R, Rîmbu M, Ghenea A, Săvulescu F were in charge with data curation; Moldovan C and Rîmbu M provided formal analysis; Moldovan C, Tobă M and Ghenea A performed the investigation; Moldovan C, Cochior D and Botea F were in charge with the methodology; Moldovan C, Tobă M and Ghenea A performed the surpervision; Rusu E, Cochior D, Tobă M, Mocanu H, Adam R, Rîmbu M, Godoroja D and Ghenea A provided validation; Moldovan C and Rîmbu M performed visualization; Moldovan C, Cochior D, Tobă M and Ghenea A provided the writing of the original draft; Tobă M, Cochior D, Ghenea A and Botea F were in charge with the review and editing; all authors have read and approve the final manuscript.
Institutional review board statement: The study was conducted in accordance with the Declaration of Helsinki and approved by the Ethics Committee of Titu Maiorescu University of Bucharest, Faculty of Medicine (referral no. 11/05.04.2022), and by the Ethics Committee of Witting Clinical Hospital (referral no. 3595/24.03.2022).
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: All authors declare no conflict-of-interest.
Data sharing statement: All data is available from the corresponding authors by e-mail.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Daniela Godoroja, MD, PhD, Attending Doctor, Department of Anesthesia, Ponderas Academic Hospital, 85A Nicolae G Caramfil Street, Bucharest 014142, Romania. daligodoroja@gmail.com
Received: November 26, 2022
Peer-review started: November 26, 2022
First decision: December 13, 2022
Revised: December 16, 2022
Accepted: January 3, 2023
Article in press: January 3, 2023
Published online: January 16, 2023
Abstract
BACKGROUND

Hemorrhoidal disease (HD) is considered a low-severity pathology by both general population and physicians, but the lengthy conservative therapy and postoperative complications suggest otherwise.

AIM

To assess the effectiveness of different treatment options, both conservative and surgical, in contrast with some preexisting comorbidities.

METHODS

We conducted a retrospective, 10-yearlong study between January 2011 and December 2021 in two surgical centers, a private and a state-owned hospital. We compared the efficacy and safety of several treatment options, such as open hemorrhoidectomy, stapled hemorrhoidopexy, rubber band ligation and infrared coagulation in terms of complication rates and types and their correlation with different preexisting comorbidities such as inflammatory bowel disease (IBD), use of anticoagulant medication (AM) and liver cirrhosis. We also conducted a 20-years long PubMed research (1.263 articles) for relevant comparisons.

RESULTS

Our study recorded 10940 patients with HD, 10241 with conservative and 699 with surgical treatment. Out of these, the male-to-female ratio of 1.3, and a peak in age distribution between 59 and 68 years old (32% of patients). For the entire study, we recorded a 90% incidence of immediate pain, immediate bleeding in 1.5% (11 cases), delayed bleeding in 1.0% (7 cases), and 0.6% surgical site infections. Urinary retention was also present, with 0.2% of patients, anal stricture in 1% and fecal incontinence for 0.5% of patients (4 cases). We recorded no severe complications such as Fournier`s gangrene or rectovaginal perforations. IBD accounted for 6% of the patients, with ulcerative colitis in 12% and Chron`s disease in 10.5%. 6.6% of the patients had AM, determining 4% immediate and 2% delayed bleeding, in surgically treated patients.

CONCLUSION

Our study determined that most common complications (pain, urinary retention, bleeding, and stricture) are correlated with each surgical technique and pre-existing comorbidities.

Keywords: Retrospective, Hemorrhoidal, Postoperative, Complications, Comorbidities

Core Tip: We compared the efficacy and safety for the most widely used surgical and non-surgical solutions for hemorrhoidal pathology treatment, such as hemorrhoidectomy, stapled hemorrhoidectomy, rubber band ligation (RBL), sclerotherapy, and infrared coagulation (IRC) in terms of complication rates, types of complications and implication of different preexisting comorbidities such as inflammatory bowel disease, use of anticoagulant medication and liver cirrhosis. We determined that even if RBL, RBL and IRC or IRC alone usually only require a one-day admission model, the classic or modified Milligan-Morgan technique still provides better overall long-term results, despite initially determining a higher level of pain and bleeding.