No added advantage of Tamponade dressings for reducing pain after hemorrhoidectomy

Tamponade dressings given after Hemorrhoidectomy have no added advantage in reducing post-operative bleeding and can aggravate postoperative pain as per a new trial published in the journal BJS Open. 

One of the most common anorectal disorders is symptomatic hemorrhoids. Most of them can be managed non surgically but some cases may need hemorrhoidectomy. In such cases, pain and bleeding are common complications. To avoid post-hemorrhoidectomy bleeding many surgeons give tamponade dressings but its necessity has never been properly evaluated and compared. Hence researchers conducted an open-label, multicenter, large, randomized trial from 14 German hospitals to investigate whether the omission of tamponade dressings after hemorrhoidectomy reduces postoperative pain without increasing the risk of severe bleeding. 

Eligible patients with third- or fourth-degree hemorrhoids undergoing hemorrhoidectomy were selected and randomized to the intervention or no dressing and control or tamponade group. Nearly 950 patients were screened, 754 were randomized and 725 received the intervention. Two co-primary outcomes were analyzed by testing hierarchically ordered hypotheses. Maximum pain intensity within 48 h after surgery was compared between the groups followed by an analysis of severe bleeding complications, defined as any bleeding requiring surgical re-intervention within 7 days. Secondary outcomes included health-related quality of life, patient satisfaction, hemoglobin levels, and adverse events. 

Results:

• There were 366 patients in the intervention and 359 patients in the control group.
• The tamponade dressings group reported median pain intensity of 6 on a scale of 0 to 10.  
• Significantly less pain was reported by patients without tamponade dressings with a median pain intensity of 5 (P < 0.001).
• Five patients in each group experienced severe bleeding.
• The absolute difference for the severe bleeding rate was −0.03 percent with the 90 percent confidence interval ranging from −1.47 percent to +1.41 percent, in line with the non-inferiority aim.
• No significant between-group difference was found for secondary outcomes.

As per this study, no proven benefit could be seen in using tamponades for post-hemorrhoidectomy in relation to pain or bleeding. 

Further reading: Langenbach MR, Florescu RV, Köhler A, et al. Tamponade dressing versus no dressing after haemorrhoidectomy: multicentre, randomized clinical trial. BJS Open. 2022;6(3):zrac070. doi:10.1093/bjsopen/zrac070