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Tamponade dressing versus no dressing after haemorrhoidectomy: multicentre, randomized clinical trial
Mike Ralf Langenbach1, Razvan-Valentin Florescu2, Andreas Köhler3
1Ev. Krankenhaus Lippstadt, Department of Surgery II, University of Witten/Herdecke, Lippstadt, Germany.
BJS Open
|May 31, 2022
Summary
Omitting tamponade dressings after hemorrhoidectomy significantly reduces postoperative pain. This practice does not increase the risk of severe bleeding, offering a better patient outcome for hemorrhoid treatment.
Area of Science:
- Colorectal Surgery
- Surgical Outcomes
- Anorectal Disorders
Background:
- Symptomatic hemorrhoids are a prevalent anorectal condition.
- Hemorrhoidectomy is a common surgical treatment for severe hemorrhoids.
- Postoperative pain and bleeding are significant concerns following hemorrhoidectomy.
Purpose of the Study:
- To evaluate if omitting tamponade dressings after hemorrhoidectomy decreases postoperative pain.
- To determine if the absence of tamponade dressings increases severe postoperative bleeding.
- To compare patient-reported pain and bleeding complications between groups.
Main Methods:
- An open-label, randomized clinical trial involving 754 patients across 14 German hospitals.
- Patients with third- or fourth-degree hemorrhoids were randomized to either no dressing or tamponade dressing.
- Co-primary outcomes included pain intensity within 48 hours and severe bleeding requiring re-intervention within 7 days.
Main Results:
- Patients without tamponade dressings reported significantly less pain (median 5 vs. 6 on a 0-10 scale, P < 0.001).
- Severe bleeding occurred in 1.4% of patients in both the intervention and control groups.
- No significant difference in secondary outcomes, including quality of life and patient satisfaction, was observed.
Conclusions:
- The use of tamponade dressings after hemorrhoidectomy is associated with increased postoperative pain.
- Omitting tamponade dressings does not elevate the risk of severe postoperative bleeding.
- The findings suggest that routine tamponade dressings are not beneficial after hemorrhoidectomy.
