Open surgery for haemorrhoids in persons with spinal cord injury.

Abstract

Pilot retrospective study on the outcome of open surgery for grade III and IV haemorrhoids in patients with SCI. Haemorrhoids and anal fissures are common in patients with spinal cord injury (SCI). Grade I to III haemorrhoids are usually managed medically or by surgical ligation. Grade III and IV haemorrhoids are treated with surgical haemorrhoidectomy in the general population, but not in patients with SCI, most probably due to fear of complications. Fondation Hopale, Berck-sur Mer, France. The surgical database was searched for open haemorrhoidectomies performed between 2007 and 2016. Seventeen patients were included. There were mostly males with complete paraplegia, mean age: 50 years and mean time since injury: 15.9 years. Open haemorrhoidectomy (Milligan and Morgan) was performed for isolated haemorrhoids (n = 4), and combined with Leopold Bellan procedure (posterior anoplasty and internal sphincterotomy) for associated anal fissures (n = 13). Short-term follow-up was performed by the surgeon (post-operative weeks 2 and 6), long-term follow-up by telephone interview (mean 5.7 years, SD 1.9). At 6-weeks post-operative, no significant complications had occurred and all wounds had healed, however 1 patient had recurrence of anal fissure. At long-term follow-up, 75% of patients reported a significant improvement in anorectal symptoms. Recurrences were reported by 5 patients: 3 haemorrhoids (18%) and 2 anal fissures (25%). Anal incontinence occurred in 1 patient who required an anal plug. All patients maintained the same bowel programs as pre-operative. Open surgery procedures were well tolerated and should be considered in persons with SCI.