Ten-year multicentric retrospective analysis regarding postoperative complications and impact of comorbidities in hemorrhoidal surgery with literature review

Table 1 Distribution of patients according to clinics and procedure types

Type of treatment	Both clinics	Clinic A (n)	Clinic A (%)	Clinic B (n)	Clinic B (%)
Conservative	8144	7737	95	407	5
Minimally invasive	2097	1657	79	440	21
Surgical treatment	699	210	30	489	70

Table 2 Complete demographic details of the recorded lot

Criteria	Age group	Females				Males
		Rural		Urban		Rural		Urban
		n	%	n	%	n	%	n	%
Gender	19-28	4	2	60	6	20	5	36	3
	29-38	28	15	204	21	76	20	340	28
	39-48	32	17	308	31	156	40	392	32
	49-58	32	17	216	22	68	18	152	12
	59-68	60	32	140	14	48	12	188	15
	69-78	20	11	48	5	20	5	84	7
	79-88	12	6	12	1	-	-	36	3
	89-98	-	-	-	-	-	-	4	0.1

Table 3 Classification of cases, according to grades of hemorrhoidal disease

Grade of HD	n	%	Treatment
Grade I	8144	74	Conservative
Grade II, Grade II with at least 1 grade III, Grade III	2097	19	RBL + IRC
Grade III with at least 1 Grade IV, Grade IV	699	6%	MOH, SH, OH with ligasure

HD: Hemorrhoidal disease; RBL: Rubber band ligation; IRC: Infrared coagulation; MOH: Modified open hemorrhoidectomy; SH: Stapled hemorrhoidectomy; OH: Open hemorrhoidectomy.

Table 4 Comparison between operation times, hostpitalisation times and return to work times across all types of procedures

Criteria	Treatment option	Median (min-max)	P value
Operation times (min)	MOH	32.5 (20-45)	0.04
	OH with ligasure	22.5 (10-35)	0.05
	SH	30 (20-40)	0.05
	RBL + IRC	5.5 (2-9)	0.05
Hospitalization times (d)	MOH	4 (2-6)	0.05
	OH with ligasure	2 (1-3)	0.04
	SH	3 (2-4)	0.04
	RBL + IRC	1.5 (1-2)	0.04
Return to work times (d)	MOH	4 (2-6)	0.05
	OH with ligasure	2 (1-3)	0.05
	SH	3 (2-4)	0.05
	RBL + IRC	1 (1-1)	0.05

MOH: Modified open hemorrhoidectomy; OH: Open hemorrhoidectomy; SH: Stapled hemorrhoidectomy; RBL + IRC: Rubber band ligation + infrared coagulation.

Table 5 Complete demographic details of the recorded lot

Criteria	Complication	n	%
OH (modified milligan-morgan procedure)	Pain - immediate	664	95
	Pain - delayed	196	28
	Bleeding - immediate postop	10	1.5
	Bleeding - delayed	3	0.5
	Infections of surgical site - perianal abscess	4	0.6
	Anal stricture	10	1.5
Stapled hemorrhoidopexy	Pain	34	4.8
	Bleeding - immediate postop	28	4.0
	Bleeding - delayed
	Infections of surgical site - perianal abscess	1	0.1
	Anal stricture	6	0.8
	Fecal incontinence	1	0.2
	Urinary retention	2	0.3
Rubber band ligation and infrared coagulation	Pain - immediate	42	2
	Bleeding - immediate postop	40	1.9

OH: Open hemorrhoidectomy.

Table 6 Overall complications in our study

Class of complication	Complication	n	%
Pain	Immediate postoperative	2517	90.0
	Delayed postoperative	783	28.0
Bleeding	Immediate postoperative	42	1.5
	Delayed postoperative	28	1.0
Infections of the surgical site	Perianal abscess	14	0.5
	Pelvic abscess	3	0.1
	Fournier`s gangrene	0	0.0
Mechanical complications	Rectal or vaginal perforations	0	0.0
Anal stricture	Immediate postoperative	20	1.0
Fecal incontinence	-	14	0.5
Urinary retention	-	6	0.2

Table 7 Comparison of visual analogue scalescore and the amount of paracetamol IV.

Type of treatment	VAS 4h	VAS 8h	VAS 24h	VAS 7 d	VAS 14 d	VAS 30 d
	Median (min-max)
MOH	8 (4-12)	7 (3-11)	4 (2-6)	2 (2-2)	0	0
OH with ligasure	6 (3-9)	5 (2-8)	2 (2-2)	2 (1-3)	0	0
SH	3 (3-3)	3 (3-3)	1 (1-1)	1 (1-1)	0	0
RBL + IRC	2 (1-3)	1 (1-1)	0	0	0	0

MOH: Modified open hemorrhoidectomy; OH: Open hemorrhoidectomy; SH: Stapled hemorrhoidectomy; RBL + IRC: Rubber band ligation + infrared coagulation; VAS: Visual analogue scale.