A small amount of bleeding can occur after any type of hemorrhoidectomy, regardless if it was open or closed. It is very important to mention this during the preoperative counseling. Although six days was an average time period in our study, delayed bleeding can occur up to two weeks postoperatively. It is difficult to determine the exact amount of bleeding based on patients’ observations via telephone. In these cases, it may become necessary to make arrangements to see the patient immediately in the office or the emergency room. Vital signs and hemoglobin levels should be obtained. Any symptoms of hypovolemia will require admission to the
hospital for intravenous hydration and serial hemoglobin measurements.
Most cases of postoperative bleeding can be controlled in the office or emergency room. A Gelfoam1 (Pfizer, Inc.) 100 pack, rolled as a tampon and wrapped with Surgicel1 (Ethicon, Inc.) is introduced in the anal canal through an anoscope, only after the blood in the ampulla and the sigmoid colon is evacuated via a sigmoidscope, before insertion of the anoscope. Only very rarely is a trip to the operating room necessary, in order to identify and control the bleeding site by suture ligation. Excisional hemorrhoidectomy, dreaded over the years, can be
performed safely and with controlled pain, if designed with appropriate preoperative counseling and postoperative management.
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