Should HIV status alter indications for hemorrhoidectomy?

Abstract

PURPOSE: 

There is a widespread belief that performing hemorrhoidectomy on a patient infected with human immunodeficiency virus (HIV) is an invitation for disaster. Aim of this study was to compare morbidity of hemorrhoidectomy in HIV-positive (HIV+) with HIV-negative (HIV−) patients.

METHODS: 

Charts of 27 HIV+ and 30 HIV−male patients less than age 50 years who underwent hemorrhoidectomy were reviewed.

RESULTS: 

Mean age of the 57 study group patients was 38 years. Open hemorrhoidectomy was performed in 26 patients (46 percent), and a closed technique was used in 31 patients (54 percent). HIV+ and HIV−patient groups were well matched to all preoperative and intraoperative variables. Mean T-cell helper count in the HIV+ patient group was 301 (range, 9-1,040) cells/μl. There were no deaths, and complications were seen in 15 patients (26 percent). There was no difference in overall complication rates between HIV+ and HIV−patient groups. Urinary retention was seen in ten patients (18 percent), three of whom were HIV+ (11 percent)vs.seven of whom were HIV -(23 percent) (P=not significant). Although no patient required reoperation for bleeding, postoperative hemorrhage was seen in three patients (1 HIV+, 2 HIV -). None of the patients developed fecal incontinence. Mean time to complete wound healing was 6.8 (range, 4−12) weeks for HIV+ patientsvs.6.6 (range, 4-14) weeks for HIV−patients (P=not significant).

CONCLUSIONS: 

These data suggest that HIV status of a patient should not alter indications for surgical management of hemorrhoidal disease.