Purpose: We analyzed the differences in complications and outcomes between patients receiving local or spinal anesthesia for stapled hemorrhoidectomy.
Background: Symptomatic Grade III and IV hemorrhoids have been traditionally treated with surgical excision; however, stapled hemorrhoidectomy has become more common in the United States in the past decade. Most stapled hemorrhoidectomies are performed under general or spinal anesthesia, although reports of local anesthesia use have been published.
Methods: Fifty-one patients underwent stapled hemorrhoidectomy from October 2003- July 2006 with a single surgeon. Of these patients, 28 patients (55%) received local anesthesia and 23 patients (45%) received spinal anesthesia. All patients had either Grade III (n = 49) or Grade IV (n = 2) hemorrhoids preoperatively.
Results: The surgery was well tolerated in all patients. Four patients with local anesthesia and 1 patient with spinal anesthesia had operative complications (14% vs. 4%, NS). Early post-operative complications, of which all but one were urinary retention, occurred more frequently with spinal anesthesia when compared with local anesthesia (26% vs. 7%, p = .12). Median time to hospital discharge was significantly quicker with local anesthesia at 193 minutes than with spinal anesthesia at 320 minutes (p < .001). Late complication rates were similar for the two groups, with 2 late complications in local anesthesia patients (7%) and 1 complication in spinal patients (4%). Late complications included urinary retention on the sixth post-operative day, stricture requiring balloon dilation, and a posterior rectal ulceration. Hemorrhoid recurrence was greater when using spinal anesthesia than with local anesthesia (17% vs. 4%, p = .16).
Conclusions: Stapled hemorrhoidectomy can be done effectively using local anesthesia. Local anesthesia significantly decreases time to hospital discharge and lessens early post-operative complications, but was associated with a higher operative complication rate.