title: Lateral internal sphincterotomy together with haemorrhoidectomy for treatment of haemorrhoids: a randomised prospective study.
abstract: 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.
authors.affiliation: Department of Surgical Sciences, Second University of Naples School of Medicine, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Galizia
authors.forename: E
authors.initials: E
authors.lastname: Lieto
authors.forename: P
authors.initials: P
authors.lastname: Castellano
authors.forename: L
authors.initials: L
authors.lastname: Pelosio
authors.forename: V
authors.initials: V
authors.lastname: Imperatore
authors.forename: C
authors.initials: C
authors.lastname: Pigantelli
mesh_terms: 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