Prospective survey of secondary bleeding following anorectal surgery in a consecutive series of 1,269 patients

SummaryIntroductionAs little data is available about secondary bleeding after proctological surgery, we conducted a specific survey.Patients and methodsPatients operated between November 2008 and April 2009 were prospectively included. Patients were followed until last visit (day 21–28). Severity of bleeding was low (at home stay), moderate (hospitalisation for observation), or severe (transfusion, and/or homeostasis in operating room).ResultsIncluded were 1269 patients: haemorrhoidectomy/pexy 527 (41%), fistula treatment 273 (21%), fissurectomy 197 (15%), perianal and pilonidal abscesses 124 (10%), others 148 (12%). Before surgery 78 patients were under long-term treatment with antiplatelet or anticoagulant therapy. Seventy-eight patients (6%) demonstrated 85 bleeding events. Severity rate was: low 22%, moderate 51%, and severe 27%. Ninety-five percent of events occurred before day 15. Univariate study showed increased risk after haemorrhoidopexy (P < 10−3) and anticoagulant treatment (P = 0.002), decreased risk after fissurectomy and fistulotomy (P < 10−3), and no relation with age, sex or operator. After multivariate study only relationship with anticoagulant treatment remained significant.ConclusionSecondary bleeding occurred in 6% of patients after proctological surgery, requiring a readmission and/or an active treatment in about 75%. Treatment with anticoagulant exposed to increased bleeding frequency.