Related Experiment Video
Updated: Jun 23, 2026
06:28
E-Patient Counseling Trial E-PACO: Computer Based Education versus Nurse Counseling for Patients to Prepare for Colonoscopy
Published on: August 1, 2019
8.4K
Preoperative enema for anal surgery: randomized clinical trial
Meng-Che Tsai1, Ting-Yu Su2, Kee-Thai Kiu3
1Department of General Medicine, Chiayi Chang-Gung Memorial Hospital, Puzi City, Chiayi County 613, Taiwan.
BJS Open
|June 2, 2025
Summary
Routine preoperative enemas offer no significant benefits for patients undergoing anal surgery. This study found no reduction in pain or complications, suggesting enemas can be omitted, particularly for stapled haemorrhoidopexy and anal fistula procedures.
Area of Science:
- Proctology
- Surgical Procedures
- Patient Outcomes
Background:
- Haemorrhoidal and anal fistula surgeries are common proctological procedures.
- The necessity of preoperative enemas remains debated in surgical practice.
- This study aimed to clarify the efficacy of preoperative enemas in anal surgery.
Purpose of the Study:
- To evaluate the efficacy and benefits of preoperative enemas in patients undergoing anal surgery.
- To compare postoperative pain, analgesic use, and complication rates between patients receiving and not receiving preoperative enemas.
- To analyze outcomes based on specific surgical procedures, including haemorrhoidectomy and anal fistula repair.
Main Methods:
- A randomized clinical study was conducted with 266 patients diagnosed with grade III or IV haemorrhoids or anal fistulas.
- Patients were divided into two groups: one receiving a preoperative enema and a control group without an enema.
- Primary outcomes included visual analogue scale (VAS) scores and analgesic usage (postoperative days 0-7); secondary outcomes were complications like surgical site infection, bleeding, and urinary retention.
Main Results:
- Overall, no significant differences in VAS scores, analgesic consumption, or complications were found between the enema and control groups.
- Subgroup analyses for stapled haemorrhoidopexy and anal fistula surgery showed no significant differences.
- A significant reduction in VAS scores was observed in the enema group compared to the control group on postoperative days 2, 3, and 4 for Milligan-Morgan haemorrhoidectomy patients.
Conclusions:
- Preoperative enemas do not provide additional benefits or reduce complications in general anal surgery.
- The routine use of preoperative enemas can be omitted in anal surgery.
- Findings suggest omitting enemas is particularly appropriate for stapled haemorrhoidopexy and anal fistula surgery, though benefits were noted for Milligan-Morgan haemorrhoidectomy.
Related Concept Videos
01:25Assessment of the Rectum and Anus
Evaluating the rectum and anus plays a crucial role in conducting a thorough physical examination of the gastrointestinal system. Although it may be uncomfortable and often embarrassing for the patient, it holds immense diagnostic value, particularly in detecting gastrointestinal diseases and abnormalities. This guide will explain how to perform this assessment using inspection and palpation methods.
Rectal Inspection
Begin by inspecting the perianal and anal areas for color, texture, rashes,...
Rectal Inspection
Begin by inspecting the perianal and anal areas for color, texture, rashes,...
01:25Endoscopic Procedures II: Colonoscopy
The colon, or large intestine, is the final segment of the digestive system. Its primary functions include absorbing water and vitamins produced by gut bacteria and transforming waste from liquid to solid to form stool. In adults, the large intestine is approximately 5 feet long and consists of four main sections:
01:26Endoscopic Procedures IV: Sigmoidoscopy and Laproscopy
Sigmoidoscopy and laparoscopy are distinct medical procedures that enable physicians to internally inspect different parts of the GI tract. Although they serve different purposes, each is essential for diagnosing and, in some cases, treating various medical conditions.
Sigmoidoscopy
Sigmoidoscopy is a diagnostic procedure that uses a flexible sigmoidoscope equipped with a light source and camera to examine the rectum and sigmoid colon. The procedure involves inserting the tube through the anus...
Sigmoidoscopy
Sigmoidoscopy is a diagnostic procedure that uses a flexible sigmoidoscope equipped with a light source and camera to examine the rectum and sigmoid colon. The procedure involves inserting the tube through the anus...
01:23Lower GI Series: Barium Enema
A Barium Enema, or a lower GI series, is a specialized radiographic examination designed to visualize the lower gastrointestinal tract, specifically the colon and rectum. This procedure is instrumental in diagnosing various conditions such as colorectal cancer, polyps, diverticulosis, and inflammatory bowel disease.
Procedure Details
The examination begins by inserting a lubricated rectal tube into the patient's rectum to administer a radiopaque barium solution. The barium flow is carefully...
Procedure Details
The examination begins by inserting a lubricated rectal tube into the patient's rectum to administer a radiopaque barium solution. The barium flow is carefully...
01:22Aneurysm IV: Nursing Management
Vigilant monitoring for aneurysm rupture is essential for patients undergoing aortic surgery.Preoperative Nursing ManagementContinuously monitor the patient for manifestations of aneurysm rupture, such as pallor, weakness, tachycardia, hypotension, abdominal, back, groin, or periumbilical pain, changes in consciousness, and a pulsating abdominal mass. Regularly assess the patient's peripheral pulses.Instruct the patient to consume a clear liquid diet the day before surgery and administer...