Prospective survey of secondary bleeding following ano-rectal surgery in a consecutive series of 1269 patients: P160

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Aim:To review the incidence of secondary haemorrhage following ano-rectal surgery.Method:Retrospective case record review.Results:Of 1269 patients, 527 (41%) underwent haemorrhoidectomy/pexy, 273 (21%) had fistula treatment, 197 (15%) had excision of anal fissure, 124 (10%) had drainage of perianal or pilonidal abscesses and 148 (12%) had otherprocedures. Seventy patients were taking aspirin and/or clopidogrel, and 18 were on anticoagulants (AC) with or without concomitant antiplatelet (AP) therapy. AP therapy was either not interrupted or stopped 5 days before and resumed on the day of surgery. Anticogulants were always stopped with appropriate low molecular weight heparin (LMWH) cover. Seventy-seven patients (6%) bled 84 times. Severity was mild in 22%, moderate in 51% and severe 27%. Bleeding rates were 10% for abscess treatment, 9.7% for haemorrhoidectomy and 8.5% for transanal rectalprolapse resection. Bleeding occurred in three patients on antiplatelet therapy (5%, P > 0.05), six on anticoagulants (33%, P < 0.001), and 67 (6%) without treatment. Bleeding severity was not influenced by treatment. More patients under AC bled repeatedly.Conclusion:Secondary bleeding occurred in 6% of patients afterproctological surgery. Antiplatelet therapy did not increase the bleeding rate. Anticoagulation therapy was associated with increased bleeding frequency and recurrence.

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