DOI: http://dx.doi.org/10.18203/2349-2902.isj20210913

Efficacy of haemorrhoidectomy versus haemorrhoidectomy with internal sphincterotomy in treatment of haemorrhoids: a retrospective randomized controlled trial study

Rajasekar Selvarajan

Abstract


Background: Role of internal sphincterotomy along with hemorrhoidectomy in reducing the pain among the cases with hemorrhoids is still a debate among most of the surgeons. Hence this study was conducted to compare the efficacy of haemorrhoidectomy with or without internal sphincterotomy in reducing the post-operative pain among the patients with haemorrhoids.  

Methods: A hospital based randomized controlled trial study was conducted among the patients with haemorrhoids undergoing surgical intervention for the same in department of general surgery in Sri Muthukumaran Medical College Hospital and Research Institute, Chennai, during the study period from July 2017 to December 2019. A total of sixty cases with haemorrhoids were included in the study. Patients in group A (n=30) underwent haemorrhoidectomy alone and group B (n=30) underwent haemorrhoidectomy along with internal sphicterectomy. Data entry was done using Microsoft excel and data was analyzed using Statistical Package for Social Sciences (SPSS) version 17.

Results: In the present study, mean pain scores on first three post-operative days and the duration required to resume the normal activities was found to be low in the group who underwent haemorrhoidectomy with internal sphincterectomy compared to the group who underwent haemorrhoidectomy alone. Duration of surgical procedure and the complications were found to be similar in both haemorrhoidectomy with internal sphincterectomy group and haemorrhoidectomy alone, group.  

Conclusions: Haemorrhoidectomy with lateral Internal Sphincterotomy is better in terms of less pain but the complications were similar in both groups.  


Keywords


Haemorrhoidectomy, Internal sphincterotomy, Pain, Haemorrhoids

Full Text:

PDF

References


Quraishy SM, Idris F, Sultan N. Outpatient treatment of hemorrhoids with electronic coagulatorinitial experience with 103 patients. Med Spectrum. 1999;21:20-2.

Suchdev S, Ghayassuddin M, Younus SM, Mirani AJ, Ghias N, Qazi A, et al. Calcium Channel Blockers for pain relief after haemorrhoidectomy; a randomized controlled trial from Karachi, Pakistan. Pak J Surg. 2014;30(2):187-92.

McConnell JC, Khobchandani IT. Long-term follow-up of closed hemorrhoidectomy. Dis Col Rect. 1983;26:797–9.

Safwan AT. Routine internal sphincterotomy with the hemorrhoidectomy for third and fourth degree hemorrhoids greatly improves the outcome. Int J Geo-Enginee. 2003;4(1):48-51

Davies J, Duffy D, Boyt N, Aghahoseini A, Alexander D, Leveson S. Botulinum toxin (botox) reduces pain after hemorrhoidectomy: results of a double-blind, randomized study. Dis Colon Rectum. 2003;46:1097-102

Di Bella F, Esteinne G. Indications for internal medioposterior with anoplasty of lateral sphincterectomy during hemorrhoidectomy, our experience. Minerva Chirurgica, Mar 1990, 45(6):361-3

Rotholtz NA, Bun M, Mauri MV, Bosio R, Peczan CE, Mezzadri NA. Long term assessment of fecal incontinency after lateral internal sphincterotomy. Tech Coloprocto. 2005; 9:115-8.

Mortensen PE, Olsen J, Pedersen IK, Christiansen J. A randomized study on hemorrhoidectomy combined with anal canal dilatation. Dis Col Rect. 1987;19:755– 7.

Eisenhammer S. Internal anal sphincterotomy plus free dilatation versus anal stretch with special criticism of the ananl stretch procedure for hemorrhoids: the recommended modern approach to hemorrhoid treatment. Dis Col Rect. 1974;17:493–522.

Chen WS, Leu SY, Wang FM. The roles of hemorrhoidectomy and lateral internal sphincterotomy in the treatment of hemorrhoids: clinical and manometric study. Zhonghua Yi Xue Za Zhi. 1989;43:255–60.

William A, Zbar A, Kmiot W. Anorectal Investigation. A Companion to Specialist Surgical Practice Colorectal Surgery. 2nd ed. Philadelphia: W.B. Saunders; 2001.

Otho S, Dalwani AG, Memon KN, Shaikh NA, Sushel C, Syed BM. Haemorrhoidectomy with internal sphincterotomy: A useful method to relieve post operative pain. J Liaquat Uni Med Health Sci. 2015;14(02):73-7.

Hosseini, seyed V, KH Sharifi, Azadeh A, parvaz SH B, Saeideh P, Mosalaei M. Role of internal sphincterotomy in the treatment of hemorrhoids: a randomized clinical trial. 2007:504-8.

Kamruzzaman M, Rashid MH, Kabir N, Rahman MM, Khan MM. A Comparative Study Between open Hemorrhoidectomy with Lateral Internal Sphincterotomy And Hemorrhoidectomy Without Lateral Internal Sphincterotomy. Int Organizat Scient Res. 2018;57-60

Diana G, Guercio G, Cudia B, Ricotta C. Internal sphincterotomy reduces postoperative pain after Milligan Morgan haemorrhoidectomy. Bio Med Cent Surg. 2009;9(1):16.

Das DK, Choudhury UC, Lim ZS. Effectiveness of internal sphincterotomy in reducing post open hemorrhoidectomy pain: a randomized comparative clinical study. Int J Collaborat Res Inter Medic Pub Heal. 2013;5(6).

Raza MW. Haemorrhoidectomy with and without lateral internal sphinterotomy. J Rawalp Medic Col. 2013;17(2):189-91.

Abedidost S, Poya M, Shafe SM. The effect of internal sphincterotomy on post hemorrhoidectomy pain. Arak Med Univ J. 2011;14(56):58-63.

Mathai V, Ong BC, Ho YH. Randomized controlled trial of lateral internal sphincterotomy with haemorrhoidectomy. Brit J Surg. 1996;83(3):380-2.