title: Usefulness of lateral internal sphincterotomy in reducing postoperative pain after open hemorrhoidectomy.
abstract: The aim of the present study was to evaluate the effect of lateral internal sphincterotomy on pain after open hemorrhoidectomy. From 1998 to 2003, seventy-eight (78) patients with fourth-degree hemorrhoids were included in this prospective randomized trial. The patients were randomized into two equal groups of 39 patients. Patients from group I underwent Milligan-Morgan hemorrhoidectomy. Patients from group II, quite apart from Milligan-Morgan hemorrhoidectomy, underwent lateral internal sphincterotomy up to the dentate line, in the left hemorrhoidectomy wound. One surgeon from the Department, who did not know to which group the patients belonged, evaluated the postoperative course in all the patients. After the first bowel movement, there were three (7.7%) patients who did not experience any pain in the internal sphincterotomy group, while in the non-internal sphincterotomy group all patients experienced mild or moderate pain. There were also more patients who experienced excruciating pain in the non-internal sphincterotomy group than in the internal sphincterotomy group (25 vs. 18); these differences were statistically significant (p = 0.034). There was no significant difference in the Wexner Incontinence Scale between the groups (p = 0.228). The addition of lateral internal sphincterotomy to open hemorrhoidectomy seems to have a positive effect on reducing postoperative pain in a few patients, without affecting the postoperative complications rate.
authors.affiliation: Fourth Surgical Department, Aristotle University of Thessaloniki, G. Papanikolaou' General Regional Hospital, 57010 Exohi, Thessaloniki, Greece. ik@hol.gr
authors.forename: Ioannis
authors.initials: I
authors.lastname: Kanellos
authors.forename: Emmanouil
authors.initials: E
authors.lastname: Zacharakis
authors.forename: Emmanouil
authors.initials: E
authors.lastname: Christoforidis
authors.forename: Stamatis
authors.initials: S
authors.lastname: Angelopoulos
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Kanellos
authors.forename: Manousos Georgios
authors.initials: MG
authors.lastname: Pramateftakis
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Betsis
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006484:Hemorrhoids / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000517:prevention & control*; D012007:Rectum / Q000601:surgery*