Severe Postoperative Bleeding After Stapled Hemorrhoidopexy: Incidence and Causes

Severe postoperative bleeding (SPB) represents a major issue of stapled hemorrhoidopexy (SH). The aim of the study is to assess SPB events over last 6 years. This essay is a retrospective study of clinical records on SH patients over a 6-year period 2012-2018 in the First Affiliated Hospital of a university. SPB events and other serious complications are assessed. A total of 41 of 3350 SH patients experienced SPB events and 49 SPB episodes (98%, 49/50) occurred within 14 postoperative days. Of the 41 SPB patients, 37 were discharged, 28 were identified as anastomotic bleeding, and 34 had an average Hb decrease of 33.9 g/l (range, 5-90 g/l). Univariate and multivariate analyses show the statistical significance between the SPB events and variables of surgeon group (p = 0.017 < 0.05), constipation (p = 0.030 < 0.05) and incarcerated hemorrhoid (p = 0.015 < 0.05). No postoperative mortality, rectal perforation, extrarectal/abdominal hemorrhage, and severe pelvic infection have been reported. SPB's incidence is 1.25% and usually occurs within 2 weeks after SH. Patients with incarcerated hemorrhoid or constipation are more prone to SPB events, and extensive surgical experience can significantly reduce SPB events.