Outpatient hemorrhoidectomy under perianal anesthetics infiltration

Hemorrhoidectomy is the most effective long-term treatment for hemorrhoids, mostly done in an inpatient setting requiring general or spinal anesthesia.

To assess the safety and early post-operative results of outpatient closed hemorrhoidectomy under perianal anesthetics infiltration.

A retrospective study of outpatient closed hemorrhoidectomy under perianal block during March 2002 and May 2003 in an ambulatory facility of the Department of Surgery, Siriraj Hospital, Bangkok.

Fifty-five patients with third-degree or fourth-degree internal hemorrhoids underwent outpatient closed hemorrhoidectomy under perianal block, including 40 males and 15 females. The mean age was 44.4 +/- 12.2 years (21-72 years). Sites of hemorrhoidectomy at each operation were single 53%, double 42% and triple 5%. Mean operative time was 20.7 +/- 9.9 minutes (5-60 minutes). Additional anal procedures were performed in 6 cases. Severity of early postoperative pain were mild in 35% of the patients, moderate in 40% of the patients and severe in 25% of the patients which could be relieved by oral analgesic drug, mostly lasting less than three days. No postoperative urinary retention occurred. The patients could pass their stool in 1.2 +/- 0.8 days postoperatively (0-4 days). No postoperative complications were found in the present study. All patients needed no hospital admission or an emergency department visit.

Outpatient hemorrhoidectomy under perianal anesthetics infiltration is effective and well tolerated. It should be an alternative approach in the treatment of hemorrhoidal disease.