Lower-Extremity Motor Neuropathy Following a Hemorrhoidectomy Performed in the Left Lateral Position: Analysis of Four Cases

Abstract

Background. The hemorrhoidectomy procedures were performed in the left lateral position at Chang Gung Memorial Hospital (CGMH). Occasionally, postoperative lower-extremity motor neuropathy occurred after the hemorrhoidectomy. Methods. From 1999 to 2003, 6,903 patients underwent hemorrhoidectomy in the left lateral position at CGMH. Postoperative foot drop was subsequently diagnosed in four of these patients. The presentation and management of this condition were recorded in these four cases. Results. Left foot drop was diagnosed in two of the four patients and right foot drop in the other two. One procedure was performed under general anesthesia, two were performed using epidural anesthesia and the last with spinal anesthesia. EMG and NCV studies revealed S1 radiculopathy in one case and sciatic neuropathy in the other three. Further, one of them combined sciatic and common peroneal neuropathies. All four patients recovered within one to six weeks without obvious morbidity. Conclusions. Lower-extremity motor neuropathy following hemorrhoidectomy performed in the left lateral position is rare. If foot drop occurs post surgery, electrodiagnostic study is indicated. Irrespective of whether it is caused by sciatic neuropathy or S1 radiculopathy, most patients with lower-extremity motor neuropathy will achieve almost total recovery within months.