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


METHODS
Randomised prospective study.


METHODS
Teaching hospital, Naples.


METHODS
48 consecutive patients with prolapsed piles who had anorectal manometry; 10 healthy volunteers served as controls.


METHODS
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.


METHODS
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.
Galizia
G
G
Department of Surgical Sciences, Second University of Naples School of Medicine, Italy.
Lieto
E
E
Castellano
P
P
Pelosio
L
L
Imperatore
V
V
Pigantelli
C
C
D000328:Adult; D001003:Anal Canal / Q000601:surgery*; D005242:Fecal Incontinence / Q000209:etiology*; D005260:Female; D006484:Hemorrhoids / Q000209:etiology / Q000601:surgery*; D006801:Humans; D008297:Male; D008365:Manometry; D008875:Middle Aged; D010149:Postoperative Pain / Q000209:etiology; D011183:Postoperative Complications / Q000209:etiology*; D011446:Prospective Studies