RANDOMIZED CONTROLLED STUDY TO EVALUATE THE EFFICACY AND CONVENIENT OF ELECTRONIC BIDET FOR PAIN CONTROL AND WOUND HEALING AFTER OPERATION FOR ANAL DISEASE, COMPARED TO CONVENTIONAL SITZ BATH
Yoon-Hye Kwon*1, Kyu Joo Park1, Seung-Bum Ryoo1, Sang Hui Moon1, Heung-Kwon Oh2, Seung Chul Heo3, Rumi Shin3, Kee Ho Song4, Hyung-Joong Jung4
1Surgery, Seoul National Univ. Hospital, Seoul, Korea (the Republic of); 2Surgery, Seoul National University Bundang Hospital, Bundang, Korea (the Republic of); 3Surgery, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea (the Republic of); 4Daehang Hospital, Seoul, Korea (the Republic of)
Many patients who undergo hemorrhoidectomy suffer from severe postoperative anal pain. Although disputed by some doctors, warm water sitz bath is still commonly recommended to relieve pain and promote wound healing. However, preparing for sitz bath is not easy, and maintaining appropriate temperature is difficult. Electronic bidet is a convenient automatic device for cleansing the perineal area, especially after defecation. In this study, we analyzed the efficacy and convenience of electronic bidet (EB) with very low force flow system as compared to conventional sitz bath (CSB) for pain control and wound healing after hemorrhoidectomy.
Patients undergoing hemorrhoidectomy were randomly assigned to use EB or CSB. All patients were instructed to take an EB or CSB at least once every morning and additionally whenever pain occurred from the next day of the surgery. The degree of postoperative pain was evaluated daily at the same time for 4 weeks before and after use of EB or CSB with a subjective Visual Analog Scale (VAS) multiplied with 10 (range 0-100). Patients visited the outpatient clinic every week to evaluate the healing status of the hemorrhoidectomy wounds. Complete healing was defined as wound is epithelialized without discharge. On the postoperative 4th week, questionnaire survey on satisfaction and convenience of EB or CSB was conducted. Primary end point was the differences in pain at 1-week postoperatively. Secondary endpoints were wound healing at 4-week postoperatively, satisfaction and convenience of using EB or CSB.
Among a total of 75 patients, 34 patients were assigned to EB and 41were assigned to CSB. Mean age was 50.85 ± 11.35 years and 18 patients (52.9%) in EB and 18 patients (43.9%) in CSB were male. Mean postoperative VAS score at 1-week was similar in both groups (38.26 ± 21.87 in EB and 40.71 ± 21.64 in CSB, p=0.63). Wound healing rate at 4-weeks was 100% in both groups. Most common postoperative complication was skin tag (9 in EB and 12 in CSB) and other complications were postoperative bleeding (4 in EB and 2 in CSB), diarrhea (1 in CSB) and transient constipation (1 in EB).
On questionnaire survey on satisfaction, concerning the water temperature, 10 patients (24.4%) in CSB were dissatisfied and all patients in EB were satisfied. For the convenience of use, 8 patients with CSB (19.5%) were dissatisfied and all EB patients were satisfied. As for the overall satisfaction, 29 (85.3%) patients in EB and 29 (70.7%) patients in CSB responded with satisfaction.
In conclusion, EB was not inferior for pain control and wound healing after hemorrhoidectomy compared to CSB. In the satisfaction evaluation, EB received higher rating than CSB in water temperature and convenience of use. EB could be used in place of CSB after hemorrhoidectomy.
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