Comparison of postoperative results after hemorrhoidectomy under local and spinal anesthesia

Background

Hemorrhoidectomy is commonly performed under general or regional anesthesia; nevertheless, the underutilization of local anesthesia is attributed to safety concerns. The aim of this study was to compare postoperative outcomes following hemorrhoidectomy using local anesthesia and spinal anesthesia.

Methods

This study was a retrospective cohort study, conducted at the General Surgery Department of the University Medical Center Ho Chi Minh City Branch 2 from January 2018 to September 2023, focused on Milligan-Morgan hemorrhoidectomies for third or fourth-degree hemorrhoids.

Results

A total of 114 patients with third or fourth-degree hemorrhoids were included in the study, with 59 patients in the local anesthesia group and 55 patients in the spinal anesthesia group. Throughout all three time points, average pain scores were consistently lower in the local anesthesia group. The average recovery time for the local anesthesia group was 8.34 ± 6.17 days, and for the spinal anesthesia group, it was 10.50 ± 7.01 days. However, these differences were not statistically significant (p > 0.05). Notably, the local anesthesia group exhibited a significantly lower rate of postoperative complications compared to the spinal anesthesia group (0 % versus 5.5 %, respectively). Additionally, the local anesthesia group had a significantly shorter length of stay (11.07 ± 15.81 h) and lower medical costs (7,793,187 ± 1,835,713 VND) compared to the spinal anesthesia group (32.87 ± 26.06 h and 9,468,098 ± 2,883,630 VND, respectively).

Conclusions

Hemorrhoidectomy under local anesthesia is feasible and safe, and local anesthesia may be considered as an alternative to spinal anesthesia in some cases.