Day Case Haemorrhoidectomy under Local Anaesthesia and Conscious Sedation

Abstract

Background: Excisional haemorrhoidectomy engenders considerable pain and has popularly been managed as an in-patient procedure. There has been anxiety over a major complication occurring in the community instead of in the hospital which is still pervasive in the developing world despite evidence to the contrary. Aim: It compared the post operative complications, time to bowel action, and post-operative pain scores in patients who had open haemorrhoidectomy either under spinal anaesthesia as in-patient or under local anaesthesia as day case procedure. Materials and Methods: The study involved two populations of patients who underwent open haemorrhoidectomy either under spinal anesthesia or under local anaesthesia with conscious sedation at the Korle Bu Teaching Hospital between 2008 and 2013. Results: It involved 275 patients made up of 145 and 130 in the spinal and local aneasthesia groups respectively. Their mean age was 43.1, SD ± 13.2 and median 41 years. Complications occurred in 44 patients (16%), 24 and 20 in the spinal and local aneasthesia groups respectively, with bleeding being the most frequent [11/44, (25%)] and significant. More wound bleeding occurred in the spinal than the local anaesthesia group, 7 vs. 2 patients. Except one day only (p = 0.0001) the mean pain scores on days 2, 3, 5 and 7 were statistically significantly lower in the spinal group than in the local group. The median time to bowel motion was 4 days in both groups. Conclusion: The post operative outcomes in the two populations were similar except the more frequent bleeding noted in the spinal anaesthesia group. Day case haemorrhoidectomy is safe in centres where day case surgery is routinely performed.