Haemorrhoidectomy in outpatient practice

Objective: To evaluate our results of haemorrhoidectomy done as an outpatient procedure.

Design: Retrospective study.

Setting: University hospital Bratislava, Slovak Republic.

Subject: 256 patients who required haemorrhoidectomy in 1996–2001.

Interventions: Milligan-Morgan haemorrhoidectomy under local (0.5% lignocaine with adrenaline 1:200000, 100 ml) or epidural (0.5 bupivacaine, marcain, 20 ml; or 1% lignocaine, 20 ml).

Main outcome measures: Mortality, morbidity, need for admission to hospital, and acceptability to patients.

Results: No patient died. All patients were observed in the recovery room for 0.5–8 hours (mean 5 hours). 23 of the 256 patients (9%) developed minor complications including bleeding (n = 6), pain (n = 15), anal discharge (n = 1), and retention of urine (n = 1). 5 patients (2%) were admitted for pain or retention of urine. During the first 3 days after operation 29 patients required increased analgesia for discomfort. 223 patients (87%) were satisfied with outpatient treatment, while the remaining would have preferred to be admitted to hospital.

Conclusion: Day case haemorrhoidectomy is a safe and effective way of reducing costs without increasing morbidity, mortality, and is acceptable to most patients.