Tsai Meng-Che, Su Ting-Yu, Kiu Kee-Thai, Yen Min-Hsuan, Chen Ying-Wei, Tam Ka-Wai, Huu Tuan Ly, Chang Tung-Cheng
Department of General Medicine, Chiayi Chang-Gung Memorial Hospital, Puzi City, Chiayi County 613, Taiwan.
Department of General Medicine, Wan-Fang Hospital Taipei Medical University, Taipei City 116, Taiwan.
BJS Open. 2025 May 7;9(3). doi: 10.1093/bjsopen/zraf023.
Haemorrhoidal surgery and anal fistula surgery are two of the most common procedures in proctology. Currently, there is no definitive consensus on the need to administer a preoperative enema. The objective of this study was to evaluate the efficacy and benefits of preoperative enemas in anal surgical procedures.
Patients diagnosed with grade III or IV haemorrhoids and anal fistulas at the Taipei Medical University Shuang-Ho Hospital, Taiwan, between 2022 and 2023, were enrolled in a randomized clinical study comparing the use of preoperative enema (intervention) versus no preoperative enema (control). The primary outcome measures included postoperative visual analogue scale scores and analgesic usage from postoperative day 0 to day 7. Secondary outcomes of interest were postoperative complications, including surgical site infection, postoperative bleeding and urinary retention. Subgroup analyses were performed according to the type of procedure for the same outcomes.
A total of 266 patients were enrolled in this study, with 133 allocated to the enema group and 133 to the control group. No significant differences were observed in postoperative visual analogue scale scores, analgesic consumption and postoperative complications between the two groups. Subgroup analysis revealed that patients undergoing stapled haemorrhoidopexy and anal fistula surgery also showed no significant differences in postoperative visual analogue scale scores, analgesic consumption, and postoperative complications between the enema and control groups. However, in the subgroup of patients undergoing Milligan-Morgan haemorrhoidectomy, the mean(s.d.) visual analogue scale score was significantly higher in the control group than in the enema group on day 2 (5.69(2.14) versus 3.77(2.45), P = 0.021), day 3 (5.85(2.61) versus 3.92(2.73), P = 0.042) and day 4 (5.23(2.55) versus 3.42(2.18), P = 0.027).
Preoperative enema in anal surgery did not yield additional benefits or reduce complications when compared with patients who did not undergo enema before anal surgery. Based on the study findings, its use can be omitted in anal surgery, especially for patients undergoing stapled haemorrhoidopexy and anal fistula surgery.
痔手术和肛瘘手术是直肠肛管外科最常见的两种手术。目前，对于术前是否需要灌肠尚无明确共识。本研究的目的是评估术前灌肠在肛门外科手术中的疗效和益处。
2022年至2023年期间，在台湾台北医学大学双和医院诊断为III或IV级痔疮和肛瘘的患者被纳入一项随机临床研究，比较术前灌肠（干预组）与不进行术前灌肠（对照组）的效果。主要观察指标包括术后第0天至第7天的视觉模拟评分和镇痛药物使用情况。感兴趣的次要结局是术后并发症，包括手术部位感染、术后出血和尿潴留。针对相同结局，根据手术类型进行亚组分析。
本研究共纳入266例患者，其中133例分配至灌肠组，133例分配至对照组。两组术后视觉模拟评分、镇痛药物消耗及术后并发症方面均未观察到显著差异。亚组分析显示，接受吻合器痔上黏膜环切术和肛瘘手术的患者，灌肠组和对照组在术后视觉模拟评分、镇痛药物消耗及术后并发症方面也无显著差异。然而，在接受Milligan-Morgan痔切除术的亚组患者中，对照组在术后第2天（5.69(2.14) 对3.77(2.45)，P = 0.021）、第3天（5.85(2.61) 对3.92(2.73)，P = 0.042）和第4天（5.23(2.55) 对3.42(2.18)，P = 0.027）的平均（标准差）视觉模拟评分显著高于灌肠组。
与肛门手术前未进行灌肠的患者相比，肛门手术前进行灌肠并未带来额外益处或减少并发症。基于研究结果，肛门手术中可省略灌肠，尤其是接受吻合器痔上黏膜环切术和肛瘘手术的患者。
