title: Improvement of wound healing after hemorrhoidectomy: a double-blind, randomized study of botulinum toxin injection.
abstract: 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.
authors.affiliation: Department of Surgery 1st Division, University of Palermo, Palermo, Italy.
authors.forename: Rosalia
authors.initials: R
authors.lastname: Patti
authors.forename: Piero L
authors.initials: PL
authors.lastname: Almasio
authors.forename: Vito M R
authors.initials: VM
authors.lastname: Muggeo
authors.forename: Salvatore
authors.initials: S
authors.lastname: Buscemi
authors.forename: Matteo
authors.initials: M
authors.lastname: Arcara
authors.forename: Saverio
authors.initials: S
authors.lastname: Matranga
authors.forename: Gaetano
authors.initials: G
authors.lastname: Di Vita
mesh_terms: 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
chemical_list: D018726:Anti-Dyskinesia Agents; D012965:Sodium Chloride; D001905:Botulinum Toxins