title: Functional and structural abnormalities after milligan hemorrhoidectomy: a comparison with healthy subjects.
abstract: BACKGROUND
  Fecal incontinence is a rare but well-known adverse effect of hemorrhoidectomy.
  
  
  OBJECTIVE
  The objective of this study was to identify possible reasons for incontinence after hemorrhoidectomy.
  
  
  METHODS
  We conducted a retrospective comparative study.
  
  
  METHODS
  The study was performed in 1 university hospital and 1 general district hospital serving 2 counties in central Sweden.
  
  
  METHODS
  In a cohort of 418 patients with consecutive Milligan hemorrhoidectomies, 40 reported fecal incontinence that was attributed to surgery. Of these, 19 patients agreed to participate. Fifteen age- and sex-matched patients from the same cohort who were operated on, but without symptoms of incontinence, were also studied, as was a third reference group of 19 age- and sex-matched persons serving as a population-based control group.
  
  
  METHODS
  All of the participants answered a bowel function questionnaire and underwent clinical evaluation, including rectoscopy, anal manometry, saline infusion test, and endoanal ultrasound.
  
  
  METHODS
  We evaluated anal resting and squeeze pressures, sphincter defects, and continence function.
  
  
  RESULTS
  The symptomatic patients had higher incontinence scores than the control groups (p = 0.00002). The mean resting pressure at the high-pressure zone was also reduced in this group (p = 0.047). External sphincter injuries were detected in 4 (20%) of 19 subjects compared with none in the control group (p = 0.11). Saline infusion test in the patients reporting incontinence showed reduced ability to hold liquids compared with healthy controls (p = 0.004).
  
  
  CONCLUSIONS
  This study was limited by selection bias and limited numbers in the groups.
  
  
  CONCLUSIONS
  In the group of patients reporting incontinence after hemorrhoidectomy, there was a proportion with sphincter defects and impaired sphincter function. These results indicate a need for cautious patient selection and improved or alternative surgical techniques.
authors.affiliation: Department of Surgery, Falu Central Hospital, Center for Clinical Research, Falun, Sweden.
authors.forename: Helgi Örn
authors.initials: HÖ
authors.lastname: Johannsson
authors.forename: Lars
authors.initials: L
authors.lastname: Påhlman
authors.forename: Wilhelm
authors.initials: W
authors.lastname: Graf
mesh_terms: D000368:Aged; D001003:Anal Canal / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000601:surgery; D003672:Defecation / Q000502:physiology*; D019160:Endosonography; D005242:Fecal Incontinence / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology; D005260:Female; D061865:Hemorrhoidectomy / Q000009:adverse effects*; D006484:Hemorrhoids / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008297:Male; D008365:Manometry; D008875:Middle Aged; D011312:Pressure; D011795:Surveys and Questionnaires; D016896:Treatment Outcome