Lateral internal sphincterotomy together with haemorrhoidectomy for treatment of haemorrhoids: a randomised prospective study

• Published in: The European journal of surgery 2000-03, Vol.166 (3), p.223-228
• Main Authors: Galizia, Gennaro, Lieto, Eva, Castellano, Paolo, Pelosio, Luigi, Imperatore, Vincenzo, Pignatelli, Carlo
• Format: Article
• Language: English
• Subjects: Adult; Anal Canal - surgery; Biological and medical sciences; Fecal Incontinence - etiology; Female; Gastroenterology. Liver. Pancreas. Abdomen; Hemorrhoids - etiology; Hemorrhoids - surgery; Humans; Male; Manometry; Medical sciences; Middle Aged; Other diseases. Semiology; Pain, Postoperative - etiology; Postoperative Complications - etiology; Prospective Studies; Stomach, duodenum, intestine, rectum, anus; Stomach. Duodenum. Small intestine. Colon. Rectum. Anus; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system
• ISSN: 1102-4151; 1741-9271
• DOI: 10.1080/110241500750009320

Objective: To investigate anorectal manometric findings in patients with haemorrhoids and to evaluate the clinical effects and physiological consequences of adding a lateral internal sphincterotomy (LIS) to haemorrhoidectomy. Design: Randomised prospective study. Setting: Teaching hospital, Naples. Patients: 48 consecutive patients with prolapsed piles who had anorectal manometry; 10 healthy volunteers served as controls. Interventions: Resting and squeeze pressures, sphincter length and rectoanal inhibitory reflex were recorded. 6 patients were excluded because anal pressures were not raised, so 42 patients were randomised. 22 patients had haemorrhoidectomy plus LIS; and 20 had haemorrhoidectomy alone. Main outcome measures: Morbidity, continence, and anorectal manometry. Results: Sphincter anomalies were found in 87.5% (n = 42) of patients. Haemorrhoidectomy alone did not affect anal pressures, which returned to the normal ranges after sphincterotomy. Those who had LIS did better postoperatively than those who had did not. 4 patients who did not have a sphincterotomy developed anal strictures. No patient who had LIS developed incontinence of faeces. Conclusions: High anal pressures are common in patients with haemorrhoids suggesting that they may have a pathogenetic role; anorectal manometry is useful in the investigation of anal pressure patterns; and when indicated, lateral sphincterotomy avoids pain, urinary retention, and stenosis, and is safe. Copyright © 2000 Taylor and Francis Ltd.