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

Introduction: As little data is available about secondary bleeding after proctological surgery, we conducted a specific survey. Patients and methods: Patients 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). Results: Included 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. Conclusion: Secondary 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. (C) 2010 Elsevier Masson SAS. All rights reserved.