Po-Chung Lin1, Min-Hsuan Yen2, Kee-Thai Kiu2, Yu-Chun Yen3, Ka-Wai Tam4,5,6, Tung-Cheng Chang7,8. 1. Department of General Medicine, Chi Mei Medical Center, No.901, Zhonghua Rd. Yongkang Dist, Tainan City, 71004, Taiwan. 2. Division of Colorectal Surgery, Department of Surgery, Shuang Ho Hospital, Taipei Medical University, Number 291, Zhongzheng Road, Zhonghe District, New Taipei City, 235, Taiwan. 3. Biostatistics Center, Office of Data Science, Taipei Medical University, No.172-1, Sec. 2, Keelung Rd, Taipei City, 106, Taiwan. 4. Division of General Surgery, Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Number 291, Zhongzheng Road, Zhonghe District, New Taipei City, 235, Taiwan. 5. Division of General Surgery, Department of Surgery, Shuang Ho Hospital, Taipei Medical University, Number 291, Zhongzheng Road, Zhonghe District, New Taipei City, 235, Taiwan. 6. Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan. 7. Division of Colorectal Surgery, Department of Surgery, Shuang Ho Hospital, Taipei Medical University, Number 291, Zhongzheng Road, Zhonghe District, New Taipei City, 235, Taiwan. rotring810@yahoo.com.tw. 8. Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan. rotring810@yahoo.com.tw.
Abstract
BACKGROUND: Hemorrhoidal surgery is a common treatment for high-grade hemorrhoids. The necessity of preoperative enema preparation (PEP) in hemorrhoidal surgery is inconclusive. This study aims to evaluate the benefit and safety of PEP in hemorrhoidal surgery. METHODS: This comparative study analyzed data from electronic medical record database and outpatient questionnaire archive. Data of patients who underwent hemorrhoidal surgery from March 2020 to February 2021 were obtained. Patients were allocated to either the PEP or non-PEP group. Primary outcome measurements were postoperative pain and oral analgesic use. Secondary outcomes were the number of days until first defecation, length of hospital stay, time to return to work, incidence of urinary retention, delayed bleeding, and local infection. RESULTS: Data of 270 consecutive patients, with 130 and 140 in the PEP and non-PEP groups, respectively, who underwent hemorrhoidal surgery were analyzed. Most patients underwent stapled hemorrhoidopexy, with 106 (81.54%) in PEP group and 113 (80.71%) in non-PEP group. The mean pain score was significantly higher in PEP than in non-PEP group at day 0 (6.21 ± 3.23 vs 5.31 ± 3.14), day 1 (5.79 ± 2.89 vs 4.68 ± 3.02), and day 2 (5.35 ± 2.86 vs 4.42 ± 2.76). No significant differences in postoperative recovery or complications rate were noted between groups. CONCLUSION: Our findings revealed that performing PEP before hemorrhoidal surgery produced no benefit when compared with not performing PEP. Typically, the procedure of PEP is inconvenient and discomforting for patients. Therefore, we suggest that it can be omitted in hemorrhoidal surgery.
BACKGROUND: Hemorrhoidal surgery is a common treatment for high-grade hemorrhoids. The necessity of preoperative enema preparation (PEP) in hemorrhoidal surgery is inconclusive. This study aims to evaluate the benefit and safety of PEP in hemorrhoidal surgery. METHODS: This comparative study analyzed data from electronic medical record database and outpatient questionnaire archive. Data of patients who underwent hemorrhoidal surgery from March 2020 to February 2021 were obtained. Patients were allocated to either the PEP or non-PEP group. Primary outcome measurements were postoperative pain and oral analgesic use. Secondary outcomes were the number of days until first defecation, length of hospital stay, time to return to work, incidence of urinary retention, delayed bleeding, and local infection. RESULTS: Data of 270 consecutive patients, with 130 and 140 in the PEP and non-PEP groups, respectively, who underwent hemorrhoidal surgery were analyzed. Most patients underwent stapled hemorrhoidopexy, with 106 (81.54%) in PEP group and 113 (80.71%) in non-PEP group. The mean pain score was significantly higher in PEP than in non-PEP group at day 0 (6.21 ± 3.23 vs 5.31 ± 3.14), day 1 (5.79 ± 2.89 vs 4.68 ± 3.02), and day 2 (5.35 ± 2.86 vs 4.42 ± 2.76). No significant differences in postoperative recovery or complications rate were noted between groups. CONCLUSION: Our findings revealed that performing PEP before hemorrhoidal surgery produced no benefit when compared with not performing PEP. Typically, the procedure of PEP is inconvenient and discomforting for patients. Therefore, we suggest that it can be omitted in hemorrhoidal surgery.
Authors: Oded Zmora; Ahmad Mahajna; Barak Bar-Zakai; Danny Rosin; Dan Hershko; Moshe Shabtai; Michael M Krausz; Amram Ayalon Journal: Ann Surg Date: 2003-03 Impact factor: 12.969