Postoperative management

The outpatient model for elective hemorrhoidectomy has become firmly established, however postoperative ambulatory management continues to be challenging, and scientific evidence guiding decision making remains limited. Several good analgesic options exist, including NSAIDS, long-acting local anesthesia, and opioids, and there is evidence available to suggest that combination therapy, incorporating two or more of these agents together, results in more effective symptom relief. Strong evidence also exists that judicious use of operative intravenous fluids is capable of reducing urinary retention, a commonly encountered postoperative difficulty. Other adjuvant modalities, including topical antibiotics and ointments, remain available with some evidence to support their use; however, overall popularity remains limited.