Comparison of emergency and elective haemorrhoidectomy.

A total of 704 patients with symptomatic prolapsed haemorrhoids were operated on over a 24-month period. Overall, 500 underwent elective haemorrhoidectomy for symptomatic prolapsed haemorrhoids and 204 emergency haemorrhoidectomy for acutely prolapsed, thrombosed or gangrenous haemorrhoids. The mean age was 43 (range 16-80) years in patients undergoing elective surgery and 42 (range 20-86) years in those receiving emergency procedures. After elective surgery 27 patients (5.4 per cent) had an episode of secondary haemorrhage; ten (2.0 per cent) required blood transfusion and six (1.2 per cent) needed surgical haemostasis. After emergency surgery, ten patients (4.9 per cent) developed secondary haemorrhage; four (2.0 per cent) required blood transfusion and two (1.0 per cent) surgical haemostasis. Twelve patients (5.9 per cent) developed anal stenosis after an emergency procedure compared with 15 (3.0 per cent) after elective operation. None of the patients in either group developed portal pyaemia. After elective surgery 26 patients (5.2 per cent) developed a degree of incontinence (eight to flatus, 15 to liquids, three to solids) as did nine patients (4.4 per cent) after emergency procedures (three to flatus, five to liquids, one to solids). Recurrent haemorrhoids were found in 38 patients (7.6 per cent) after elective surgery and in 14 (6.9 per cent) after an emergency procedure.