Sun XW, Xu JY, Zhu CZ, Li SJ, Jin LJ, Zhu ZD. Analysis of factors impacting postoperative pain and quality of life in patients with mixed hemorrhoids: A retrospective study. World J Gastrointest Surg 2024; 16(3): 731-739 [PMID: 38577073 DOI: 10.4240/wjgs.v16.i3.731]
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Xiao-Wen Sun, Chang-Zhen Zhu, Si-Jia Li, Lu-Jia Jin, Zhi-Dong Zhu, Department of Gastrointestinal Surgery, Tsinghua University Affiliated Beijing Tsinghua Changgeng Hospital, Beijing 102218, China
Jing-Yi Xu, Surgical Department, Tsinghua University Affiliated Beijing Tsinghua Changgeng Hospital, Beijing 102218, China
Co-first authors: Xiao-Wen Sun and Jing-Yi Xu.
Author contributions: Sun XW, Xu JY, and Zhu ZD proposed the concept of this study, Zhu CZ participated in the data collection work, and Sun XW and Xu JY drafted the initial draft; Li SJ and Jin LJ contributed to the formal analysis of this study, while Zhu ZD conducted guiding research, methodology, and visualization; Xu JY validated the study, and all authors participated in the study and jointly reviewed and edited the manuscript; Sun XW and Xu JY have made equal contributions to this work as co-first authors.
Institutional review board statement: This study has been reviewed and approved by the Medical Ethics Committee of Tsinghua University Affiliated Beijing Tsinghua Changgeng Hospital.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: We declare that there is no disclosure of any interest relationship.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Received: January 12, 2024 Peer-review started: January 12, 2024 First decision: January 31, 2024 Revised: February 5, 2024 Accepted: February 27, 2024 Article in press: February 27, 2024 Published online: March 27, 2024 Processing time: 70 Days and 7.5 Hours
Abstract
BACKGROUND
Hemorrhoids are among the most common and frequently encountered chronic anorectal diseases in anorectal surgery. They are venous clusters formed by congestion, expansion, and flexion of the venous plexus in the lower part of the rectum. Mixed hemorrhoids bleed easily and recurrently, and this can result in severe anemia. Hence, they may have a negative effect on the health of the patient and surgical treatment is required. Milligan-Morgan hemorrhoidectomy has been widely used since 1937 for the treatment of grade III and IV hemorrhoids. However, most patients experience different degrees of postoperative pain that may cause anxiety.
AIM
To assess the factors influencing pain scores and quality of life (QoL) in patients with mixed hemorrhoids post-surgery.
METHODS
The clinical data of patients with mixed hemorrhoids who underwent Milligan-Morgan hemorrhoidectomy were collected retrospectively. The basic characteristics of the enrolled patients with mixed hemorrhoids were recorded, and based on the Goligher clinical grading system, the hemorrhoids were classified as grades III or IV. The endpoint of this study was the disappearance of pain in all patients. Quantitative data were presented as mean ± SD, such as age, pain score, and QoL score. Student’s t-test was used to compare the groups.
RESULTS
A total of 164 patients were enrolled. The distribution of the visual analog scale pain scores of all patients at 3, 7, 14 and 28 d after surgery showed that post-surgery pain was significantly reduced with the passage of time. Fourteen days after the operation, the pain had completely disappeared in some patients. Twenty-eight days after the surgery, none of the patients experienced any pain. Comparing the World Health Organization Quality of Life – BREF self-reporting questionnaire scores of patients between 14 and 28 d after surgery, we observed that the quality-of-life scores of the patients post-surgery had significantly improved. There were six items that were compared at 14- and 28-d post-surgery. The mean QoL score 28 d after surgery (4.79 ± 0.46) was higher than that at 14 d post-surgery (3.79 ± 0.57). The mean health condition score 28 d after surgery (4.80 ± 0.41) was also higher than that at 14 d post-surgery (4.01 ± 0.62). The mean physical health score 28 d after surgery (32.10 ± 2.96) was significantly higher than that at 14 d post-surgery (23.41 ± 2.85). The mean psychological health score 28 d after surgery (27.22 ± 1.62) was significantly higher than that at 14 d post-surgery (21.37 ± 1.70). The mean social relations score 28 d after surgery (12.21 ± 1.59) was significantly higher than that at 14 d post-surgery (6.32 ± 1.66). The mean surrounding environment score 28 d after surgery (37.13 ± 2.88) was significantly higher than that at 14 d post-surgery (28.42 ± 2.86). The differences in quality-of-life scores at day 14 and day 28 post-surgery were observed to be statistically significant (P < 0.001).
CONCLUSION
Milligan-Morgan hemorrhoidectomy can significantly improve the postoperative QoL of patients. Age, sex, and the number of surgical resections were important factors influencing Milligan-Morgan hemorrhoidectomy.
Core Tip: Milligan-Morgan hemorrhoidectomy improves postoperative quality of life in patients with mixed hemorrhoids. Factors such as age, sex, and number of surgical resections influence the outcome of the procedure. Post-surgery pain decreases over time, with complete pain disappearance observed in some patients after 14 d. Quality-of-life scores significantly improve after surgery, particularly in physical and psychological health, social relations, and surrounding environment. This study highlights the positive impact of Milligan-Morgan hemorrhoidectomy on patients' quality of life and emphasizes the importance of considering various factors during the procedure.
