title: Long-term manometric study of anal sphincter function after hemorrhoidectomy.
abstract: OBJECTIVE
  Data on maximum resting pressure (MRP) and maximum squeeze pressure (MSP) changes after hemorrhoidectomy are not univocal and follow-up of patients undergoing surgery is mostly short-lived. The aim of this study was to prospectively examine during 1-year follow-up the long-term manometric results of MRP, MSP, and ultra slow wave activity (USWA) within a set of patients undergoing Milligan-Morgan hemorrhoidectomy as compared to healthy controls.
  
  
  METHODS
  Twenty patients with hemorrhoids of third and fourth degree were enrolled and anorectal manometry was performed preoperatively, on the 5th day, and after 1, 6, and 12 months after surgery.
  
  
  RESULTS
  On the 5th and 30th day after hemorrhoidectomy, USWA was slightly increased as compared to preoperative status. Six and 12 months after surgery, patients with USWA were significantly less in comparison to preoperative assessment without differences with healthy subjects. After surgery, MSP values were not significantly different to baseline values. On the 5th postoperative day after hemorrhoidectomy, MRP was significantly greater than baseline preoperative values. Thirty days after surgery, MRP values were similar to those detected preoperatively, but still significantly increased as compared to healthy subjects. After 6 and 12 months, MRP values were significantly lower than those detected during preoperative phase and comparable to healthy subjects.
  
  
  CONCLUSIONS
  Our data support that Milligan-Morgan hemorrhoidectomy induces a complete resolution of typical manometric alterations of disease and that the excision of anal cushions is responsible only for mild and transient alteration of anal continence.
authors.affiliation: Department of Surgical and Oncological Science, Division of General Surgery, University of Palermo, Palermo, Italy.
authors.forename: Rosalia
authors.initials: R
authors.lastname: Patti
authors.forename: Piero Luigi
authors.initials: PL
authors.lastname: Almasio
authors.forename: Matteo
authors.initials: M
authors.lastname: Arcara
authors.forename: Massimiliano
authors.initials: M
authors.lastname: Sparacello
authors.forename: Stefania
authors.initials: S
authors.lastname: Termine
authors.forename: Sebastiano
authors.initials: S
authors.lastname: Bonventre
authors.forename: Gaetano
authors.initials: G
authors.lastname: Di Vita
mesh_terms: D000328:Adult; D001003:Anal Canal / Q000503:physiopathology*; D013505:Digestive System Surgical Procedures / Q000009:adverse effects*; D005242:Fecal Incontinence / Q000209:etiology / Q000503:physiopathology*; D005260:Female; D005500:Follow-Up Studies; D006484:Hemorrhoids / Q000601:surgery*; D006801:Humans; D008297:Male; D008365:Manometry; D008875:Middle Aged; D011312:Pressure; D011446:Prospective Studies