Can Prophylactic Antibiotics Prevent Surgical Site Infection After Hemorrhoidectomy?

Sometimes, the best treatment option for hemorrhoids is either dietary management or no therapy at all. For patients who have bleeding, painful, prolapsing internal hemorrhoids, surgeons can offer several office-based procedures, such as injection sclerotherapy, infrared coagulation, and rubber-band ligation, which all accomplish shrinkage and scarring of hemorrhoids. But when hemorrhoids don’t respond to those interventions or are gangrenous, recurrent, or thrombosed, surgery may be the only treatment option.

The Standards Practice Task Force of the American Society of Colon and Rectal Surgeons (ASCRS) recently published a guideline for the management of hemorrhoids; however, it offers no recommendation on antimicrobial prophylaxis before hemorrhoidectomy. Intuitively, many physicians consider hemorrhoidectomy to be a “dirty” operation that is prone to surgical site infection due to diverse fecal flora on or near the post-hemorrhoidectomy wound. While prophylactic antibiotics seem reasonable, evidence supporting or refuting its necessity is scarce.

The March 2014 issue of Diseases of the Colon and Rectum included a multisite, retrospective study designed to determine whether antibiotic prophylaxis reduces surgical site infection after hemorrhoidectomy.

The researchers conducted a medical record review on 852 patients undergoing closed hemorrhoidectomy at different institutions. which made their study roughly 8-fold larger than any previously published single-site findings. They identified patients with preoperative risk factors and found that 7.7% were current or previous smokers, 2.5% had diabetes, 0.8% were taking corticosteroids, and 0.2% had Crohn’s disease.

Approximately 40% of the patients received antibiotic prophylaxis, although the incidence of postoperative surgical site infection was 1.4%. Among those 12 patients with infections, 9 had not been given antibiotic prophylaxis.

Using multivariate regression analysis, the researchers determined that no perioperative risk factor was associated with increased risk of postsurgical site infection. Among the patients who received antibiotic prophylaxis, no drug-related complications such as Clostridium difficile colitis and diarrhea were noted.

The authors concluded postoperative surgical site infection is exceedingly rare after hemorrhoidectomy, and routine antibiotic prophylaxis seems to be unnecessary.