Annals of Coloproctology

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Original Articles

Benign proctology,Postoperative outcome & ERAS,Complication

Predictors of postoperative urinary retention after semiclosed hemorrhoidectomy: Hong Yoon Jeong, Seok Gyu Song, Jong Kyun Lee; Ann Coloproctol. 2022;38(1):53-59. Published online July 21, 2021; DOI: https://doi.org/10.3393/ac.2021.00304.0043

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19 Citations

Purpose
This study was performed to analyze the predictors that might contribute to urinary retention following semiclosed hemorrhoidectomy under spinal anesthesia.
Methods
This retrospective study enrolled 2,176 consecutive patients with symptomatic grade III to IV hemorrhoids who underwent semiclosed hemorrhoidectomy between September 2018 and September 2019.
Results
Among the 2,176 patients, 1,878 (86.3%) had no postoperative urinary retention, whereas 298 (13.7%) developed urinary retention after hemorrhoidectomy. The percentage of males was significantly higher in the retention group than in the non-retention group (60.4% vs. 48.1%; P=0.001). The risk of urinary retention was 1.52-fold higher in males than in females (95% confidence interval [CI], 1.13–2.04; P=0.005), 1.62-fold higher in old age (95% CI, 1.14–2.28; P=0.006), and 1.37-fold higher with high body mass index (BMI) (95% CI, 1.04–1.81; P=0.025). Patients with ≥4 resected hemorrhoids had a higher odds ratio (OR) of 1.46 (95% CI, 1.12–1.89; P=0.005) than patients with <4 resected hemorrhoids. Among the supplementary medication, patients who used analgesics had a higher OR of 2.06 (95% CI, 1.57–2.68; P=0.001) than those who did not.
Conclusion
Male sex, age, high BMI, number of resected hemorrhoids, and supplementary analgesics are independent risk factors for urinary retention after semiclosed hemorrhoidectomy.

Citations

Citations to this article as recorded by

Real-world outcomes of hemorrhoidectomy with and without advanced energy devices: A propensity score-matched analysis from a tertiary center
I-Chun Huang, Hsin Hsu, Jayson Enn Ming Wong, Kun-Yu Tsai, Shu-Huan Huang
Current Problems in Surgery.2026; 77: 101981. CrossRef
The effect of methylene blue infiltrating injection on anal pain after Milligan–Morgan surgery: A randomized controlled clinical study
Jing Zhu, Heng Deng, Ming Li, Kun Tang
Medicine.2026; 105(7): e47613. CrossRef
Assessment of the efficacy and safety of pudendal nerve block in post-hemorrhoidectomy pain: A meta-analysis of randomized controlled trials
Jun Li, Hai-Qiong Wu, Jun-Tao Zhang, Shi-Jian Liu, Ke-Lin Peng
Asian Journal of Surgery.2025; 48(3): 1607. CrossRef
Latest Research Trends on the Management of Hemorrhoids
Sung Il Kang
Journal of the Anus, Rectum and Colon.2025; 9(2): 179. CrossRef
Ice Packing Versus Warm Sitz Baths for Post-hemorrhoidectomy Pain Management: A Randomized Controlled Trial
Pin-Chun Chen, Yi-Kai Kao, Po-Wen Yang, Chia-Hung Chen, Chih-I Chen
Diseases of the Colon & Rectum.2025; 68(7): 865. CrossRef
Defining the reliability of bladder scan in patients with obesity with postoperative urinary retention
Parit T. Mavani, Pranay S. Ajay, Heather B. Wagner, Benjamin I. Meyer, Monali Shah, Caitlin P. Sok, Adriana C. Gamboa, Subir Goyal, Jeffrey M. Switchenko, Shishir K. Maithel, David A. Kooby, Mihir M. Shah
Surgery.2025; 185: 109547. CrossRef
Spontaneous rupture of the urinary bladder following hemorrhoidectomy: A case report
Hanieh Raghimi, Rahim Jorjani, Sina Mohajernoei, Nasrollah Abian, Hossein Saffari, Ehsan Zolfi
International Journal of Surgery Case Reports.2025;[Epub] CrossRef
Hemorrhoidal Disease
Jean H. Ashburn
JAMA.2025; 334(17): 1541. CrossRef
Surgical outcomes of modified Ferguson hemorrhoidectomy for grade IV hemorrhoidal disease
Ahmet Cihangir Emral, Gökay Çetinkaya, Merter Gülen, Bahadır Ege
Anatolian Current Medical Journal.2025; 7(5): 652. CrossRef
Ultrasound-guided trans-perineal pudendal nerve block for post-hemorrhoidectomy voiding complications: a prospective randomized double-blinded study
Alrefaey K. Alrefaey, Shaimaa Ezzat Amin, Fahad S AL Amri
BMC Anesthesiology.2025;[Epub] CrossRef
Comparison of the effect of hot and cold compresses on post‐operative urinary retention in older patients: A clinical trial study
Tayebeh Mirzaei, Farkhondeh Roudbari, Ali Ravari, Sakineh Mirzaei, Elham Hassanshahi
International Journal of Urological Nursing.2024;[Epub] CrossRef
General anesthesia with local infiltration reduces urine retention rate and prolongs analgesic effect than spinal anesthesia for hemorrhoidectomy
Chun-Yu Lin, Yi-Chun Liu, Jun-Peng Chen, Pei-Hsuan Hsu, Szu-Ling Chang
Frontiers in Surgery.2024;[Epub] CrossRef
Effective non-surgical treatment of hemorrhoids with sclerosing foam and novel injection device
Juan Cabrera Garrido, Gonzalo López González
Gastroenterology & Endoscopy.2024; 2(4): 176. CrossRef
Effect of incision location and type of fistula on postoperative urinary retention after radical surgery for anal fistula: a retrospective analysis
Chen Li, Ningyuan Liu, Zichen Huang, Zijian Wei, Keyi Li, Wenxiao Hou, Sangyu Ye, Lihua Zheng
BMC Gastroenterology.2024;[Epub] CrossRef
Ten-year multicentric retrospective analysis regarding postoperative complications and impact of comorbidities in hemorrhoidal surgery with literature review
Cosmin Moldovan, Elena Rusu, Daniel Cochior, Madalina Elena Toba, Horia Mocanu, Razvan Adam, Mirela Rimbu, Adrian Ghenea, Florin Savulescu, Daniela Godoroja, Florin Botea
World Journal of Clinical Cases.2023; 11(2): 366. CrossRef
Effect of single spinal anesthesia with two doses ropivacaine on urinary retention after hemorrhoidectomy in male patients
Lei-lei Wang, Meng Kang, Li-xin Duan, Xu-fei Chang, Xiao-xin Li, Xiang-yang Guo, Zhi-yu Kang, Yong-zheng Han
Frontiers in Surgery.2023;[Epub] CrossRef
Efficacy of Low-Frequency Electroacupuncture on Urinary Retention After Spinal Anesthesia
Mina Olia, Aliakbar Jafarian, Masood Mohseni
Journal of PeriAnesthesia Nursing.2023; 38(5): 745. CrossRef
Laser hemorrhoidoplasty combined with blind hemorrhoidal artery ligation compared to Milligan–Morgan hemorrhoidectomy in patients with second and third degree piles; a prospective randomized study
Amir F. Abdelhamid, Mohamed M. Elsheikh, Osama H. Abdraboh
The Egyptian Journal of Surgery.2023; 42(3): 669. CrossRef
Tarlov cyst with self-healing cauda equina syndrome following combined spinal-epidural anesthesia: a case report
Zhexuan Chen, Chuxi Lin
BMC Anesthesiology.2023;[Epub] CrossRef

Effect of Hyperoxygenation During Surgery on Surgical Site Infection in Colorectal Surgery: Mina Alvandipour, Farzad Mokhtari-Esbuie, Afshin Gholipour Baradari, Abolfazl Firouzian, Mehdi Rezaie; Ann Coloproctol. 2019;35(1):9-14. Published online February 28, 2019; DOI: https://doi.org/10.3393/ac.2018.01.16

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13 Web of Science
16 Citations

Abstract PDF

Purpose
Despite the use of different surgical methods, surgical site infection is still an important cause of mortality and morbidity in patients and imposes a considerable cost on the healthcare system. Administration of supplemental oxygen during surgery has been reported to reduce surgical site infection (SSI); however, that result is still controversial. This study was performed to evaluate the effect of hyperoxygenation during colorectal surgery on the incidence of wound infection.
Methods
This study was a prospective double-blind case-control study. The main aim of the study was to evaluate the effect of hyperoxygenation during colorectal surgery on the incidence of SSI. Also, secondary outcomes, such as atelectasis, pneumonia, respiratory failure, length of hospital stay, and required hospitalization in the intensive care unit were evaluated.
Results
SSI was recorded in 2 patients (2 of 40, 5%) in the hyperoxygenation group (FiO2 80%) and 6 patients (6 of 40, 15%) in the control group (FiO2 30%) (P < 0.05). Time of hospitalization was 6 ± 6.4 days in the hyperoxygenation group and 9.2 ± 2.4 days in the control group (P < 0.05).
Conclusion
This study showed a positive effect of hyperoxygenation in reducing SSI in colorectal surgery, especially surgery in an emergency setting. When the low risk, low cost, and effectiveness of this method in patients undergoing a laparotomy are considered, it is recommended for all patients undergoing colorectal surgery.

Citations

Citations to this article as recorded by

Effects of high vs. low perioperative inspired oxygen fraction on length of hospital stay and postoperative complications: a systematic review, meta-analysis, and trial sequential analysis
Mimi WU, Lanlan CHANG, Leying SUN, Zhao DAI, Jinhua BO, Xin XU
Minerva Anestesiologica.2025;[Epub] CrossRef
Perioperative oxygen therapy: an overview of systematic reviews and meta-analyses
Adel Elfeky, Yen-Fu Chen, Amy Grove, Keith Couper, Rachel Court, Sara Tomassini, Anna Wilson, Amy Hooper, Alexandra Buckle, Sharvari Vadeyar, Marion Thompson, Olalekan Uthman, Joyce Yeung
British Journal of Anaesthesia.2025; 135(5): 1456. CrossRef
Perioperative Low Fraction of Inspired Oxygen Reduces Postoperative Atelectasis in Abdominal Surgery Patients: A Systematic Review and Meta-Analysis
勇肖
Advances in Clinical Medicine.2025; 15(08): 1883. CrossRef
Perioperative oxygen therapy in patients undergoing surgical procedures: an overview of systematic reviews and meta-analyses
Adel Elfeky, Yen-Fu Chen, Amy Grove, Keith Couper, Rachel Court, Sara Tomassini, Anna Wilson, Amy Hooper, Alexandra Buckle, Sharvari Vadeyar, Marion Thompson, Olalekan Uthman, Joyce Yeung
Health Technology Assessment.2025; : 1. CrossRef
A low perioperative fraction of inspired oxygen reduces the incidence of postoperative atelectasis in patients undergoing abdominal surgery under general anesthesia: A systematic review and meta-analysis
Zuofeng Wang, Min Jiang, Cuiyuan Huang, Hengjing Zou, Yu Wen, Shan Ou
Journal of International Medical Research.2025;[Epub] CrossRef
Risk Factors for Postoperative Infections Following Appendectomy of Complicated Appendicitis: A Meta-analysis and Retrospective Single-institutional Study
Katherine Cironi, Aaron L. Albuck, Bryant McLafferty, Alison K. Mortemore, Christina McCarthy, Mohammad Hussein, Peter P. Issa, Tyler Metz, Marcela Herrera, Eman Toraih, Sharven Taghavi, Emad Kandil, Jacquelyn Turner
Surgical Laparoscopy, Endoscopy & Percutaneous Techniques.2024; 34(1): 20. CrossRef
Vermeidung postoperativer Wundinfektionen
Pernilla V. Conrad, Thomas Becker, Julius Pochhammer, Axel Kramer
Im OP.2024; 14(05): 236. CrossRef
The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for Preventing Surgical Site Infection
Benjamin D. Shogan, Jon D. Vogel, Bradley R. Davis, Deborah S. Keller, Jennifer M. Ayscue, Lindsey E. Goldstein, Daniel L. Feingold, Amy L. Lightner, Ian M. Paquette
Diseases of the Colon & Rectum.2024; 67(11): 1368. CrossRef
Updated meta-analysis on intraoperative inspired fraction of oxygen and the risk of surgical site infection in adults undergoing general and regional anesthesia
Yoann El Maleh, Charlotte Fasquel, Christophe Quesnel, Marc Garnier
Scientific Reports.2023;[Epub] CrossRef
Vermeidung postoperativer Wundinfektionen
Pernilla V. Stropnicky, Thomas Becker, Julius Pochhammer, Axel Kramer
Allgemein- und Viszeralchirurgie up2date.2023; 17(04): 301. CrossRef
The effect of high perioperative inspiratory oxygen fraction for abdominal surgery on surgical site infection: a systematic review and meta-analysis
Jae Hee Kuh, Woo-Seok Jung, Leerang Lim, Hae Kyung Yoo, Jae-Woo Ju, Ho-Jin Lee, Won Ho Kim
Scientific Reports.2023;[Epub] CrossRef
Differences in clinical and cost-effectiveness between cefmetazole and flomoxef for the prevention of surgical site infection in elective colorectal surgery: A single-center, retrospective cohort study
Yuya Urano, Shunichi Saito, Takafumi Machimoto, Yukio Tsugihashi, Hiroyasu Ishimaru, Hiroyuki Akebo, Ryuichi Sada
Journal of Infection and Chemotherapy.2022; 28(4): 510. CrossRef
Does Higher Intraoperative Fraction of Inspired Oxygen Improve Complication Rates Following Implant-Based Breast Reconstruction?
Mallory A Rowley, Kometh Thawanyarat, Jennifer K Shah, Lawrence Cai, Elizabeth Turner, Oscar J Manrique, Brian Thornton, Rahim Nazerali
Aesthetic Surgery Journal Open Forum.2022;[Epub] CrossRef
Fraction of inspired oxygen during general anesthesia for non‐cardiac surgery: Systematic review and meta‐analysis
Maria Høybye, Peter C. Lind, Mathias J. Holmberg, Maria Bolther, Marie K. Jessen, Mikael F. Vallentin, Frederik B. Hansen, Johanne M. Holst, Andreas Magnussen, Niklas S. Hansen, Cecilie M. Johannsen, Johannes Enevoldsen, Thomas H. Jensen, Lara L. Roessler
Acta Anaesthesiologica Scandinavica.2022; 66(8): 923. CrossRef
Intraoperative respiratory and hemodynamic strategies for reducing nausea, vomiting, and pain after surgery: Systematic review and meta‐analysis
Johanne M. Holst, Maibritt P. Klitholm, Jeppe Henriksen, Mikael F. Vallentin, Marie K. Jessen, Maria Bolther, Mathias J. Holmberg, Maria Høybye, Peter Carøe Lind, Asger Granfeldt, Lars W. Andersen
Acta Anaesthesiologica Scandinavica.2022; 66(9): 1051. CrossRef
Systematic Review and Meta-Analysis of Wound Bundles in Emergency Midline Laparotomy Identifies That It Is Time for Improvement
Gearóid Mc Geehan, Itoro M. Edelduok, Magda Bucholc, Angus Watson, Zsolt Bodnar, Alison Johnston, Michael Sugrue
Life.2021; 11(2): 138. CrossRef

Clinical Analysis of the Hemorrhoidectomy with Pure Local Anesthesia.: Oh, Chang Seok , Lee, Yong Jik , Ko, Soo Jong , Lee, Young Taek; J Korean Soc Coloproctol. 2007;23(1):22-27.; DOI: https://doi.org/10.3393/jksc.2007.23.1.22

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Abstract PDF: PURPOSE
We hoped to evaluate the possibility of substitution of the local anesthesia for the spinal anesthesia in hemorrhoidectomy.
METHODS
We did Milligan-Morgan hemorrhoidectomy under local anesthesia for the sixty- eight patients from January 1998 to December 2005. These patients were compared with seventy-nine patients of spinal anesthesia, sampled with similar gender, age, a surgeon, retrospectively. We used a mixture of 0.5% lidocaine and 1:200,000 epinephrine into perianal skin and intersphincteric space.
RESULTS
The male-to-female ratio was 1:1 in local anesthesia group and 1:0.84 in spinal anesthesia group. The mean age was 50 and 46 respectively. The number of excised pile was 3.9 and 3.8 respectively. The frequency of the analgegics injected within first 24 hours was 1.79 and 2.70 respectively (P=0.001). The frequency of the urinary catheterization was 0.07 and 0.69 respectively (P < 0.001). The first bowel movement after surgery was 1.2 days and 1.6 days respectively. The hospital stay was 6.4 days and 8.1 days respectively (P=0.06). CONCLUISIONS: Local anesthesia is simple, safe and effective in the hemorrhoidectomy.

Randomized Controlled Trial

Comparison of Mepivacaine and Bupivacaine as an Adjuvant of Morphine for Benign Anorectal Surgery under Caudal Anesthesia.: Yun, Sung Mun , Park, Ki Hong , Lim, Jun Sang , Kim, Sung Chul; J Korean Soc Coloproctol. 1998;14(3):517-522.

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Abstract PDF: BACKGROUND
/AIMS: The caudal anesthsia is most commonly used for benign anorectal surgery, The combination of long-acting anesthetics and opiates has been used for longer duration and successful control of postoperative pain. But the side effects of peridural anesthesics and morphine have commonly occured in caudal anesthesia. This study was performed to assess the difference in clinical effects between peridural mepivacaine and bupivacaine with morphine.
METHODS
We evaluated the clinical effects in 60 patients who had anal operation with Jack-Knife position under caudal anesthesia. We divided randomly these 60 patients into two groups, M and B groups (in each group, 30 patients included). Group M (n=30) was given 2% mepivacaine 20 ml with morphine 2 mg caudally, and Group B (n=30) was given 0.5% bupivacaine 20 ml with morphine 2 mg in the same manner. We measured the onset time, duration, postoperative analgesia, and side effects including urinary retention.
RESULTS
The onset time for analgesia was significantly shorter in group M than in group B. The duration of postoperative pain complaints was significantly longer in group M than in group B. The postoperative analgesic effects and side effects were not significantly different between two groups.
CONCLUSIONS
Caudal mepivacaine and morphine mixture is effective for control of postoperative pain without significant side effects.

Original Articles

Hemorrhoidectomy Under Local Anesthesia after Pentothal Induction versus Spinal Anesthesia: a Concurrent Nonrandomized Prospective Study.: Kang, Choong Hoon , Lee, Sang Woo , Shin, Hyeon Keun , Jeong, Seung Kyu , Choi, Jai Pyo , Yang, Hyung Kyu; J Korean Soc Coloproctol. 2006;22(1):1-7.

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Abstract PDF: PURPOSE
The aim of this study was to evaluate the effectiveness of local anesthesia compared to spinal anesthesia and the usefulness of pentothal induction before infiltration of a local anesthetic agent.
METHODS
A concurrent non-randomized prospective study was conducted on 52 patients who underwent a hemorrhoidectomy. For the spinal anesthesia (SA) group (n=29), 0.5% heavy bupivacaine (Marcaine(R)), 5 mg (1 ml), was used, and for the local anesthesia (LA) group (n=23), pentothal, 3.3 mg/kg, was administrated intravenously prior to infiltration of a mixture of local anesthetics (2% lidocaine, 14 ml, with 0.5% bupivacaine, 7 ml).
RESULTS
There were no differences between the two groups in terms of operating time, postoperative pain, headache, urinary difficulty, nausea or vomiting, pain-free interval after operation, analgesic requirements, and patient's or surgeon's satisfaction. Postoperative ambulation was earlier in the LA group than in the SA group.
CONCLUSIONS
Local anesthesia after pentothal induction can be used effectively for a hemorrhoidectomy and may be a safe alternative to spinal anesthesia.

Ambulatory Hemorrhoidectomy under Local Anesthesia.: Kim, Jae Han , Kim, Byung Cheol , Jang, Jeong Hwan , Kim, Cheong Yong; J Korean Soc Coloproctol. 2001;17(5):213-219.

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Abstract PDF: PURPOSE
Hemorrhoidectomy can be associated with severe pain in the immediate postoperative period. The aim of this study was to evaluate the advantages and feasibility of hemorrhoidectomy under local anesthesia (pudendal nerve block).
METHODS
From september 1998 to August 2000 we performed 77 hemorrhoidectomy with local anesthesia in our Colorectal unit under the ambulatory surgery regimen. 0.5% lidocaine and 0.25% bupivacaine mixed by 1:1 ratio were used for pudendal nerve block and local anesthesia.
RESULTS
Using pudendal nerve block, ambulatory hemorrhoidectomy with or without band ligation were done in 77 patients. Male to female ratio was 46:31, mean age was 35.2 years. 3 major piles plus 1 minor pile were present in 40 patients (51.9%). We injected mixed lidocaine and bupivacaine solution through external sphincter and puborectalis muscle. All patients were successfully operated without conversion to general anesthesia or even intravenous anesthetic injection. Postoperative pain of them were compared the patients who were operated hemorrhoidectomy under general (spinal or caudal) anesthesia during the same time. The pain were assessed using verbal rating pain scale at 24 hours, 48 hours and 72 hours (1-10, where 1 presented no pain and 10 represented the worst pain imaginable) by phone call examination. Mean pain scores for pudendal anesthesia group at 24, 48, 72 hours were 5.32, 3.07 and 2.21, respectively, compared with other anesthesia group with 6.47, 4.52 and 3.24. These differences were statistically significant (P value<0.05). Post operative pain was successfully controlled with home care and oral medications.
CONCLUSIONS
Under local anesthesia with pudendal nerve block, ambulatory hemorrhoidectomy were able to decrease pain and urinary retension in comparison to spinal or caudal anesthesia group. Ambulatory hemorrhoidectomy is useful, low cost and feasible.

Effect of Lidocaine Injected on Lower Rectal Submucosa During Hemorrhoidectomy under Caudal Anesthesia.: Kim, Tae Soo , Kim, Do Sun , Kang, Yoon Sic , Jung, Seung Yong , Cho, Hang Jun , Lee, Doo Han; J Korean Soc Coloproctol. 1998;14(1):85-89.

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Abstract PDF: BACKGROUND
/AIMS: The caudal anesthesia for anal surgery is simple and effective. Also, it is relatively safe because there is no headache or other neurologic complications. But, during the operation under caudal anesthesia, the unwanted symptoms such as lower abdominal pain or hypotensive symptoms were experienced in some patients. These unwanted symptoms may occur due to anal and lower rectal dilatation. The precise mechanism is unknown. But we speculated that some sensory nerve endings in rectal submucosa may be involved in this mechanism. So, we think that it is possible to prevent or reduce these symptoms if we block these sensory nerve endings effectively with local anesthetics. Therefore, the aim of this study is to see whether the locally injected lidocaine can reduce or prevent the unwanted symptoms during anal surgery under caudal anesthesia.
METHODS
There were 100 consecutive patients in this study who had hemorrhoidectomy with Jack-knife position under caudal anesthesia at our clinic. We divided evenly these 100 patients into two groups, injection and control groups(in each group, 50 patients were included.). In injection-group, We injected 10 cc(100 mg) of 1% lidocaine solution cir cumferentially into the lower rectal submucosa at the beginning of the operation. In control-group, we did not inject lidocaine solution initially, but the lidocaine injection was done during the operation in the same manner in the injection-group if the severe unwanted symptoms occurred. We used Parks-type retractor to dilate the anus and recorded the patient,s complaints.
RESULTS
In injection-group, male to female ratio was 33:17, mean age was 42.1 years(20~69) and mean operation time was 38.3 minutes(15~80). In control-group, male to female ratio was 25:25, mean age was 43.7 years(17~65) and mean oeration time was 38.5 minutes(15~80). Lower abdominal pain was present in 11 patients(22%) among injection-group and in 37 patients(74%) among control-group(p=0.000). Hypotensive symptoms such as nausea, vomiting, sweating and dizziness were present in 1 patient(2%) among injection-group and in 8 patients(16%) among control-group(p=0.014). We injected lidocaine solution into lower rectal submucosa during the operation in 18 patients with severe symptoms among control-group. The effect of the injected lidocaine solution in 18 control patients was good in 13(72%) and fair in 5(28%). With regard to factors influencing the occurrence of symptoms, there was a tendency of higher occurrence in male, the younger-aged and the longer-operation groups.
CONCLUSION
The lower rectal submucosal lidocaine injection reduced the unwanted symptoms such as lower abdominal pain and hypotensive symptoms during the anal surgery under the caudal anesthesia.

Randomized Controlled Trial

The Effects of Pudendal Block in Voiding Complication after Anal Surgery.: Kim, Jae Hwang , Jang, Seon Mo , Shim, Min Chul , Jee, Dae lim; J Korean Soc Coloproctol. 2000;16(6):365-370.

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Abstract PDF: Urinary retention in common benign anal surgery is a burden to ambulatory surgery. PURPOSE: To reduce voiding complication pudendal nerve block (PB) was applied in hemorrhoids surgery.
METHODS
We compared PB with spinal anesthesia (SA) for anal surgery. In this prospective study, 163 patients undergoing elective hemorrhoids surgery by single surgeon were randomized to receive either PB with 0.5% bupivacaine (n=81) with 1: 20,000 epinephrine or SA with 0.5% bupivacaine (n=83).
RESULTS
There were no statistically significant differences in patient demographics, total amount of administered fluid, time to onset of block, or intraoperative pain. All patients had a successful block for surgery however, puborectalis muscle relaxation with PB was not complete. The time from injection of the anesthetics to first development of pain was longer in the patients who received PB (9.1 vs 3.1h; P<0.001). Urinary catheterization needed in only 6 patients in PB group compared with 57 cases in SA group (p<0.001). Degree of pain was significantly low in PB (2.7 vs 5.2 with VAS; p<0.001) Injected analgesics was significantly reduced in PB (16/81 vs 45/82; p<0.001) CONCLUSIONS: Our results suggest that PB with bupivacaine results in fewer postoperative voiding complications and less pain compared with traditional SA in hemorrhoidectomy.

Original Article

Effect of the Sitting Position after Spinal Anesthesia on the Incidence of Postdural Puncture Headaches: Saddle Block versus Low Spinal Anesthesia.: Lim, Seok Won , Yoo, Dong Won; J Korean Soc Coloproctol. 2004;20(1):15-19.

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Abstract PDF: PURPOSE
Postdural puncture headache is one well-known complications of spinal anesthesia. The development of postdurals puncture headaches is related to needle size, the direction of the needle bevel, the number of dural punctures and the age of the patient. However, the effect of the sitting position after spinal anesthesia (saddle block) on the incidence of postdural puncture headaches is not yet known. This study was performed to compare the incidence rates of headaches between a saddle block group (sitting position group) and a low spinal anesthesia group (supine position group). In addition, this study was performed to identify the predisposing factors influencing postdural puncture headaches (age, sex, seasonal variation, onset of headache, location of headache).
METHODS
The authors analyzed 960 anal-surgery patients who were operated on using a saddle block or low spinal anesthesia at Hang Cinic from Jan. 2000 through Dec. 2000. The authors compared the incidence rates of headaches between the saddle block group (480 cases) and the low spinal anesthesia group (480 cases).
RESULTS
1) The incidence of postdural puncture headaches was not significantly different between the two groups (2.5% in the saddle block group, and 2.3% in the low spinal anesthesia group) (P>0.05). 2) The postdural puncture headache incidence rate was higher for younger patients (20~30 years) and for females. (M:F=7:16) (P<0.05). 3) The onest of postdural puncture headaches was at the postoperative 2nd day in 16 cases (70%) and at the postoperative 3rd day in 6 cases (26%). 4) The incidence rate of postdural puncture headache was higher in the summer (5 cases in June, and 3 cases in July, 4 cases in August). 5) The headache were located in the frontal region in 16 cases (70%) and in the occipital region in 3 cases (13%).
CONCLUSIONS
There is no significant difference in the incidence rates of postdural puncture headaches between the saddle block group and the low spinal anesthesia group. Postdural puncture headaches had a tendency to occur more frequently in young female patients and during the summer season. In addition, a more intensive study of the use of saddle block anesthesia for ambulatory anal surgery is required.

Randomized Controlled Trials

A Prospective Study on the Relationship between Postoperative Urinary Retention and Amount of Infused Fluid during Surgery of Benign Anal Diseases under Spinal Anesthesia.: Lee, Chai Young , Kim, Hee Cheol , Lee, Dong Hee; J Korean Soc Coloproctol. 1999;15(5):357-361.

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Abstract PDF: PURPOSE
Urinary retention is a frequent postoperative complication after benign anorectal surgery. Factors, known to affect postoperative urinary retention, are age, sex, anesthetics, operative method, operative time and perioperative fluid injection. This study was performed to know whether the incidence of urinary retention might be controlled by reducing the amount of perioperative fluid.
METHODS
Eighty patients underwent surgery for hemorrhoids and chronic anal fissures were allocated into two groups, fluid restriction group (n=37) and hydration group (n=43). All patients were consecutively randomized from May 1998 to January 1999 and they were under 50 years old without urologic abnormality. Fluid was infused at 100 ml/h from the midnight then it's rate was changed into 10 ml/h for 4 hours from the beginning of the anesthesia for the restriction group, whereas 1000 ml/h only during operation for the hydration group. Thereafter it was changed into the same rate with 100 ml/h on both groups.
RESULTS
There was no significant differences with regard to age, sex, operation time, degree of pain and use of analgesics between two groups. Although there was a significant difference in the total volume of the infused fluid (Restriction group: 53.4 119.5 ml versus Hydration group: 778.6 319.0 ml, mean SD, p<0.001). Catheterization was done in 29 patients of the restriction group (78.4%) and 37 patients of the hydration group (86.0%), respectively. The frequency of catheterization was 1.3 0.7 times in the former and 1.6 0.7 times in the latter group.
CONCLUSIONS
A strict restriction of fluid infusion appeared to be unnecessary for the purpose of preventing the urinary retention during surgery of benign anorectal diseases with spinal anesthesia.

The Effects of Early Ambulation on Urinary Retention and.: Kim, Seon Hahn , Lee, Il Ok , Kim, Dong Hee; J Korean Soc Coloproctol. 1999;15(3):179-185.

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Abstract PDF: INTRODUCTION: Urinary retention (UR) is one most common complication of anal surgery and its cause is multifactorial. Postdural puncture headache (PDPH) is caused by cerebrospinal fluid leakage after spinal anesthesia, therefore it may be aggravated by early ambulation. PURPOSE: To determine whether early ambulation (EA) vs. bed rest (BR) reduces the incidence of UR after anal surgery under spinal anesthesia, without causing PDPH.
METHODS
In this prospective, randomized study, 107 patients undergoing anal surgery under spinal anesthesia were randomly assigned in the EA group (n=54) or the BR group (n=53). UR was defined as a voiding difficulty that needs catheterization. In the BR group, the patients were positioned flat in bed on the operation day. Anesthetic techniques (tetracaine injection using 24-gauge needle in sitting position, bupivacaine local infiltration) and postoperative pain therapy (intramuscular demerol injection every 6 hours, oral nonsteriodal antiinflammatory drug plus acetaminophen) were standardized. Perioperative intravenous fluids were restricted.
RESULTS
Urinary retention and PDPH occurred in 32 (29.9%) and 7 (6.5%) patients, respectively. UR was significantly reduced in the EA group (10/54=18.5%) vs. the BR group (22/53=41.5%) (p=0.017, Chi-square). The incidence of PDPH, however, was not different between the two groups (5.6% in the EA vs. 7.5% in the BR group).
CONCLUSIONS
Early ambulation has important implication on reducing the incidence of urinary retention after anal surgery under spinal anesthesia, without causing PDPH.

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