Improvement of wound healing after hemorrhoidectomy: a double-blind, randomized study of botulinum toxin injection.
OBJECTIVE
Hemorrhoidectomy is usually associated with significant pain during the postoperative period. The spasm of the internal sphincter seems to play an important role in the origin of pain. This study was designed to evaluate the effectiveness of intrasphincter injection of botulinum toxin after hemorrhoidectomy in reducing the maximum resting pressure of the anal canal, accelerating wound healing, and decreasing postoperative pain when resting and during defecation.


METHODS
Thirty patients with hemorrhoids of third and fourth degree were included in the study and randomized in two groups. Anorectal manometry was performed preoperatively and 5 and 30 days afterward in all patients undergoing Milligan-Morgan hemorrhoidectomy. One group received an injection of 0.4 ml of saline into the internal anal sphincter, the other group were injected with 0.4 ml of solution containing 20 units of botulinum toxin.


RESULTS
After five days from hemorrhoidectomy, maximum resting pressure decreased in the group injected with botulinum toxin and increased in the placebo group. The time of healing and postoperative pain when resting and during defecation significantly decreased in the group treated with an injection of botulinum toxin.


CONCLUSIONS
Botulinum toxin injection into internal anal sphincter after hemorrhoidectomy is effective in reducing maximum resting pressure, time of healing, and postoperative pain both on resting and during defecation in absence of complications or side effects.
Patti
Rosalia
R
Department of Surgery 1st Division, University of Palermo, Palermo, Italy.
Almasio
Piero L
PL
Muggeo
Vito M R
VM
Buscemi
Salvatore
S
Arcara
Matteo
M
Matranga
Saverio
S
Di Vita
Gaetano
G
D000328:Adult; D001003:Anal Canal / Q000502:physiology / Q000601:surgery; D018726:Anti-Dyskinesia Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D001905:Botulinum Toxins / Q000008:administration & dosage / Q000627:therapeutic use*; D003672:Defecation; D004311:Double-Blind Method; D005260:Female; D006484:Hemorrhoids / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008365:Manometry; D008875:Middle Aged; D010146:Pain; D011312:Pressure; D012965:Sodium Chloride; D016896:Treatment Outcome; D014945:Wound Healing
D018726:Anti-Dyskinesia Agents; D012965:Sodium Chloride; D001905:Botulinum Toxins