Three-pedicle haemorrhoidectomy in the outpatient setting: the critical roles of information and organization

Three-pedicle haemorrhoidectomy (Milligan-Morgan) has traditionally raised concerns in outpatient settings due to postoperative pain and complications. Since 2015, we have performed this procedure on an outpatient basis. This study aimed to assess patients' views on such care.

We retrospectively included patients who underwent outpatient haemorrhoidectomy at our centre in 2020. A satisfaction questionnaire was sent. The primary outcome was the proportion of patients reporting good or excellent satisfaction. Secondary outcomes included hospital admissions, postoperative complications, and predictors of dissatisfaction. Ethics approval was obtained.

Among 392 patients, 292 underwent outpatient surgery (74%); 176 (60%) completed the questionnaire. Mean age was 52 ± 12 years; 64% were male. Good or excellent satisfaction was reported by 84% of respondents. Postoperatively, 9% required hospital admission, 48% contacted the hospital (nurse 52%, physician 48%) and 23% had unscheduled visits (clinic 65%, emergency department 35%). Complications occurred in 28% of cases, including discomfort, nausea, bleeding, urinary retention, and faecal impaction. Dissatisfaction was associated with poor preoperative explanations (surgeon p < 0.0001, anaesthetist p = 0.0005), complications (p = 0.0002), phone calls (p = 0.0016), and unscheduled visits (p = 0.0016). Multivariate analysis confirmed poor explanations by the surgeon (OR 0.08; p < 0.001) as an independent predictor. When asked, 79% said they would choose outpatient care again. Negative responses were independently associated with female sex (OR 0.33; p = 0.011), poor explanations (OR 0.11; p = 0.009) and unscheduled visits (OR 3.93; p = 0.02).

Outpatient haemorrhoidectomy is acceptable to the majority of patients. However, thorough information and appropriate organisation are essential. As a result, 95% of these procedures are now performed on an outpatient basis at our centre.