Safety of Hemorrhoid Procedures in Patients Who Are Immunocompromised: The Mayo Clinic Experience.
Source: PubMed, NCBI / U.S. National Library of Medicine
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 are scant. To evaluate postoperative outcomes after both office-based procedures and operative intervention for hemorrhoidal disease in immunocompromised patients. Retrospective medical record review. Single-center, tertiary referral center. Adult patients were included who had hemorrhoidal disease and primarily medication-induced immunosuppression and were undergoing an office-based procedure or operative intervention for hemorrhoidal disease while on immunosuppression at Mayo Clinic in Rochester between 2010 and 2023. The primary outcome was the development of infectious complications or wound complications. Fifty-five immunocompromised patients, with a median age of 60 years, underwent a total of 68 hemorrhoidal procedures during the study time frame. All patients had immunosuppression induced by medication, except for 1 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 more than one-third of patients each. Of 68 total interventions, hemorrh
Abstract
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 are scant. To evaluate postoperative outcomes after both office-based procedures and operative intervention for hemorrhoidal disease in immunocompromised patients. Retrospective medical record review. Single-center, tertiary referral center. Adult patients were included who had hemorrhoidal disease and primarily medication-induced immunosuppression and were undergoing an office-based procedure or operative intervention for hemorrhoidal disease while on immunosuppression at Mayo Clinic in Rochester between 2010 and 2023. The primary outcome was the development of infectious complications or wound complications. Fifty-five immunocompromised patients, with a median age of 60 years, underwent a total of 68 hemorrhoidal procedures during the study time frame. All patients had immunosuppression induced by medication, except for 1 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 more than one-third of patients each. Of 68 total interventions, hemorrhoidectomy (32%) and excision of a thrombosed hemorrhoid (26%) were the 2 most common operations performed. Sixteen adverse events were reported in 14 patients (25%). 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. The retrospective nature of the study and the heterogeneity of the study population. These data suggest that office-based and surgical procedures are safe and feasible in patients with immunosuppression. See Video Abstract . ANTECEDENTES:La enfermedad hemorroidal y la inmunosupresión son prevalentes. El tratamiento de la enfermedad hemorroidal en esta población de pacientes es difícil. La mayoría de las sociedades recomiendan un tratamiento conservador debido a los riesgos presuntos de complicaciones mórbidas, como sepsis y alteración de la cicatrización. Los datos sobre los riesgos de los procedimientos ambulatorios y quirúrgicos en pacientes inmunodeprimidos son escasos.OBJETIVO:Evaluar los resultados posoperatorios tras procedimientos ambulatorios y cirugía para la enfermedad hemorroidal en pacientes inmunodeprimidos.DISEÑO:Revisión retrospectiva de historias clínicas.ENTORNO:Centro terciario de referencia único.PACIENTES:Pacientes adultos con enfermedad hemorroidal e inmunosupresión inducida principalmente por medicamentos que se sometieron a un procedimiento ambulatorio o a una intervención quirúrgica para la enfermedad hemorroidal mientras estaban en tratamiento inmunosupresor en la Clínica Mayo de Rochester entre 2010 y 2023.PPRINCIPALES MEDIDAS DE RESULTADO:El resultado principal fue la aparición de complicaciones infecciosas o complicaciones de la herida.RESULTADOS:Cincuenta y cinco pacientes inmunodeprimidos, con una mediana de edad de 60 años, se sometieron a un total de 68 procedimientos hemorroidales durante el periodo de estudio. Todos los pacientes presentaban inmunosupresión inducida por medicación, excepto uno con síndrome de insuficiencia medular. La causa más frecuente de inmunosupresión fue la artritis reumatoide, seguida de un trasplante renal previo. Los medicamentos más frecuentes fueron los corticosteroides crónicos y el metotrexato, en más de un tercio de los pacientes. De las 68 intervenciones totales, la hemorroidectomía (32 %) y la extirpación de una hemorroide trombosada (26 %) fueron las dos operaciones más comunes realizadas. Se notificaron 16 eventos adversos en 14 (25 %) pacientes. Se documentaron tres casos de celulitis posoperatoria tras la extirpación de una hemorroide externa trombosada, una hemorroidopexia y una hemorroidectomía de Whitehead. No se administraron antibióticos intravenosos postoperatorios. No se documentaron casos de sepsis pélvica.LIMITACIONES:El carácter retrospectivo del estudio y la heterogeneidad de la población estudiada.CONCLUSIONES:Estos datos sugieren que los procedimientos ambulatorios y quirúrgicos son seguros y viables en pacientes con inmunosupresión. (AI-generated translation ).