Safety of Hemorrhoid Procedures in Patients who are Immunocompromised: The Mayo Clinic Experience.

Background: Hemorrhoidal disease and immunosuppression are prevalent. Management of hemorrhoidal disease in this patient population is challenging. Most societies recommend conservative management due to the presumed risks of morbid complications, including sepsis and impaired healing. Data on the risks of office-based and operative procedures in immunocompromised patients is scant.

Objective: To evaluate postoperative outcomes after both office-based procedures and operative intervention for hemorrhoidal disease in immunocompromised patients.

Design: Retrospective chart review.

Settings: Single-center, tertiary referral center.

Patients: Adult patients with hemorrhoidal disease and primarily medication-induced immunosuppression undergoing an office-based procedure or operative intervention for hemorrhoidal disease while on immunosuppression at Mayo Clinic in Rochester between 2010 and 2023.

Main outcome measures: The primary outcome was development of infectious complications or wound complications.

Results: Fifty-five immunocompromised patients, with a median age of 60, underwent a total of 68 hemorrhoidal procedures during the study time frame. All patients had immunosuppression induced by medication, except for one patient with bone marrow failure syndrome. The most common reason for immunosuppression was rheumatoid arthritis, followed by prior kidney transplant. The most common medications were chronic corticosteroids and methotrexate in over a third of patients each. Of 68 total interventions, hemorrhoidectomy (32%) and excision of a thrombosed hemorrhoid (26%) were the two most common operations performed. Sixteen adverse events were reported in 14 (25%) patients. Three cases of postoperative cellulitis were documented after thrombosed external hemorrhoid excision, hemorrhoidopexy, and Whitehead hemorrhoidectomy. No postoperative intravenous antibiotics were administered. No cases of pelvic sepsis were documented.

Limitations: The retrospective nature of the study and the heterogeneity of the study population.

Conclusions: These data suggest that office-based and surgical procedures are safe and feasible in patients with immunosuppression. See Video Abstract.