Bahadır Ege

Atılım University, Faculty of Medicine, Department of General Surgery, Ankara, Türkiye

Ege B. Management of Complications in Hemorrhoidal Disease Surgery. In: Ege B, editor. Hemorrhoidal Disease: Diagnosis, Treatment and Complication Management. 1^st ed. Ankara: Türkiye Klinikleri; 2025. p.105-111.

ABSTRACT

Hemorrhoidal disease is a common condition that affects a significant portion of the population, with studies indicating that up to 39% of individuals may experience hemorrhoidal disease, although many remain asymptomatic. Despite the widespread nature of the condition, hemorrhoidectomy, the surgical treatment of hemorrhoids, is generally associated with a relatively low complication rate. However, the incidence and severity of complications can vary depending on surgical technique, the extent of tissue damage during the procedure, and the type of hemorrhoidal disease treated. Common complications following hemorrhoidectomy include minor bleeding, local swelling, urinary retention, and perianal abscess formation. Serious complications, although less frequent, include rectal perforation, sepsis, and incontinence. Notably, the recurrence of hemorrhoidal disease after surgery is observed in approximately 6% of patients, requiring additional surgical intervention. urinary retention is a frequent postoperative complication, particularly when hemorrhoidectomy is performed under spinal anesthesia, affecting up to 30% of patients. This condition can be managed through conservative measures such as pain relief, fluid management, and the use of a warm water bag to reduce the need for catheterization. Similarly, urinary tract infections are a potential complication in up to 5% of patients, typically secondary to urinary retention and catheterization, and can be treated effectively with appropriate antibiotics. Bleeding is another significant concern after hemorrhoidectomy, with early postoperative bleeding requiring careful monitoring. Although it occurs in 1-2% of cases, delayed bleeding-typically occurring between 7 and 16 days post-surgery-can be more challenging to manage, often requiring anal exploration and suture ligation. Fecal incontinence is a rare but troubling complication that may occur in 2-10% of patients, usually related to sphincter damage. This condition can often improve over time, but some cases require further surgical intervention depending on the degree of continence impairment. Anal stenosis, a condition characterized by the abnormal narrowing of the anal canal, is another rare but significant complication, particularly in patients who undergo multiple hemorrhoidectomies or when excessive anoderm is removed. The incidence of anal stenosis following hemorrhoidectomy ranges from 1-3%, and its management typically involves anoplasty, with techniques such as diamond flap repair being preferred for restoring anal caliber. Infectious complications, though uncommon, may arise postoperatively and can range from superficial abscesses to more severe conditions like necrotizing fasciitis, especially in cases where surgical sterility is compromised. Postoperative pain, persistent or increasing, may signal developing necrosis or infection, necessitating prompt intervention to prevent serious consequences. In cases of severe infection or necrosis, aggressive treatment such as colostomy may be required. Stapled hemorrhoidectomy, introduced as a less painful alternative to traditional hemorrhoidectomy techniques, has its own set of potential complications, including rectal stricture, which can lead to life-threatening conditions such as sepsis or perforation if not addressed immediately. Ensuring complete tissue ring excision and performing a thorough digital rectal examination post-surgery are critical steps in preventing such complications. If stricture occurs, careful surgical revision with suture techniques can restore rectal continuity and avoid further complications. This chapter provides a comprehensive review of the management of complications following hemorrhoid surgery, emphasizing the importance of technique, postoperative care, and the appropriate handling of complications. The goal is to ensure that patients experience optimal outcomes while minimizing the risks associated with hemorrhoidectomy.

Keywords: Hemorrhoids; Complications; Bleeding; Surgical flaps; Fecal incontinence