The Role of Lateral Internal Sphincterotomy in Haemorrhoidectomy: A Study in a Tertiary Care Center

Vijayaraghavalu, Shashikanth; R, Guru Prasad; Rajkumar, Sathish

doi:10.7759/cureus.15630

Cited by 6 publications

(5 citation statements)

References 13 publications

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“…It has been observed in a few randomized controlled trials that hemorrhoidectomy in combination with lateral internal sphincterotomy resultsin relatively decreased postoperative pain and improved wound healing. 13,14 The outcome of this study is comparable with a study revealing that mean post-operative pain score in patients with open hemorrhoidectomy combined with internal sphincterotomy was 1.60±0.8 and in patients with open hemorrhoidectomy alone it was 2.32±1.16 at first 48 hours, with a P-value <0.01. Likewise, early complications including urinary retention and pain during first bowel motion after surgery were also significantly low (P<0.01) in the hemorrhoidectomy with sphincterotomy group when compared to the control group.…”

Section: Discussionsupporting

confidence: 83%

“…A study concluded on the point that post operative wound healing, pain and other complications were lesser in patients in whom lateral internal sphincterotomy was combined with hemorrhoidectomy to treat haemorrhoids. 13 A study by Vijayaraghavalu and Rajkumar 14 showed that the pain 12 hours post operatively after hemorrhoidectomy with lateral internal sphincterotomy is 5.1±1.9 as compared 6.12±2.3. This difference is statistically significant (p<0.0008).…”

Section: Discussionmentioning

confidence: 99%

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Does Lateral Internal Sphincterotomy Impact the Outcome of Haemorrhoidectomy

Afzal¹,

Khan²,

Lala³

et al. 2022

PJMHS

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Background: The most common complication after hemorrhoidectomy is almost always postoperative. This dreadful complication makes the patients postpone the treatment even for prolapsing, bleeding, and uncomfortable piles. There are different methods that can be used for reducing pain including performing a lateral internal sphincterotomy (LIS). Better outcome of hemorrhoidectomy combined with lateral internal sphincterotomy has been observed in a few past controlled trials with respect to decreased pain after surgery, and improved and early wound healing. Objective: To compare the mean post-operative pain score in patients undergoing open hemorrhoidectomy with and without lateral internal sphincterotomy for III and IV degree hemorrhoids. Study Design: Randomized control trial. Place and Duration of Study: Department of Surgery, Jinnah Hospital Lahore from 1st July 2021 to 31st December 2021. Methodology: One hundred and twenty patients with diagnosis of III & IV degree hemorrhoids were selected. They were divided in two groups, Group A included patients who underwent open hemorrhoidectomy with lateral sphincterotomy and Group B included patients who underwent open hemorrhoidectomy alone. Standard Milligan Morgan Hemorrhoidectomy was done under local anesthesia. A fine surgical blade was inserted in inter-sphincteric groove with blade parallel to the circular fibers of internal sphincter. Blade was then rotated so that it faces the lumen of the anal canal. With the surgeon’s index finger in the canal, the blade was advanced towards the index finger so as to divide the internal sphincter but not the anal mucosa. Post-operative pain was assessed at first 48 hours post operatively according to ‘Visual Analog Score’. Results: The mean age was 34.6±7.72 in Group A and 34.28±8.09 years in Group B. There were 34 (56.67%) males in Group A and 32 (53.33%) in Group B while 26 (43.33%) females in Group A and 28 (46.67%) in Group-B. The mean pain score was 1.43±0.49 in Group A and 2.03±0.74 in Group B (P=0.001). Conclusion: Open hemorrhoidectomy with lateral sphincterotomy results in significantly lower mean post-operative pain when compared to open hemorrhoidectomy alone Keywords: Hemorrhoids, Open hemorrhoidectomy, Lateral sphincterotomy, Post-operative pain

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Section: Discussionsupporting

confidence: 83%

Section: Discussionmentioning

confidence: 99%

Does Lateral Internal Sphincterotomy Impact the Outcome of Haemorrhoidectomy

Afzal¹,

Khan²,

Lala³

et al. 2022

PJMHS

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“…However, there was a significant higher rate of fecal incontinence in patients with LIS compared with those without (7.7% versus 1.25%), although the severity of fecal incontinence was mild (e.g., flatus incontinence and fecal soiling) and improved over time [ 35 ]. In 2021, a single-institute RCT of 200 patients from India also confirmed the efficacy of LIS on better pain relief after hemorrhoidectomy, without compromising anal continence [ 36 ].…”

Section: Resultsmentioning

confidence: 99%

Strategies to Reduce Post-Hemorrhoidectomy Pain: A Systematic Review

Lohsiriwat

Jitmungngan

2022

Medicina

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Background and Objectives: Excisional hemorrhoidectomy is considered as a mainstay operation for high-grade hemorrhoids and complicated hemorrhoids. However, postoperative pain remains a challenging problem after hemorrhoidectomy. This systematic review aims to identify pharmacological and non-pharmacological interventions for reducing post-hemorrhoidectomy pain. Materials and Methods: The databases of Ovid MEDLINE, PubMed and EMBASE were systematically searched for randomized controlled trails (published in English language with full-text from 1981 to 30 September 2021) to include comparative studies examining post-hemorrhoidectomy pain as their primary outcomes between an intervention and another intervention (or a sham or placebo). Results:Some 157 studies were included in this review with additional information from 15 meta-analyses. Fundamentally, strategies to reduce post-hemorrhoidectomy pain were categorized into four groups: anesthetic methods, surgical techniques, intraoperative adjuncts, and postoperative interventions. In brief, local anesthesia-alone or combined with intravenous sedation was the most effective anesthetic method for excisional hemorrhoidectomy. Regarding surgical techniques, closed (Ferguson) hemorrhoidectomy performed with a vascular sealing device or an ultrasonic scalpel was recommended. Lateral internal anal sphincterotomy may be performed as a surgical adjunct to reduce post-hemorrhoidectomy pain, although it increased risks of anal incontinence. Chemical sphincterotomy (botulinum toxin, topical calcium channel blockers, and topical glyceryl trinitrate) was also efficacious in reducing postoperative pain. So were other topical agents such as anesthetic cream, 10% metronidazole ointment, and 10% sucralfate ointment. Postoperative administration of oral metronidazole, flavonoids, and laxatives was associated with a significant reduction in post-hemorrhoidectomy pain. Conclusions: This systematic review comprehensively covers evidence-based strategies to reduce pain after excisional hemorrhoidectomy. Areas for future research on this topic are also addressed at the end of this article.

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“…A total of 12 studies compared routine haemorrhoidectomy with lateral internal sphincterotomy (LIS) against haemorrhoidectomy without LIS [45][46][47][48][49][50][51][52][53][54][55][56].…”

Section: Lateral Internal Sphincterotomy (Lis)mentioning

confidence: 99%

Can Targeting Sphincter Spasm Reduce Post‐Haemorrhoidectomy Pain? A Systematic Review and Meta‐Analysis

et al. 2022

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Background Haemorrhoidectomy is often complicated by significant post-operative pain, to which spasm of the internal anal sphincter is thought to be a contributing factor. This study appraises the evidence behind interventions aimed at lowering sphincter spasm to relieve post-haemorrhoidectomy pain. Methods A Preferred Reporting Items for Systematic Reviews and Meta-analyses compliant systematic review was conducted. Medline, EMBASE, and CENTRAL databases were systematically searched. All RCTs which compared interventions targeting the internal anal sphincter to relieve pain post excisional haemorrhoidectomy were included. The primary outcome measure was pain on the visual analogue scale. Results Of the initial 10,221 search results, 39 articles were included in a qualitative synthesis, and 33 studies were included in a meta-analysis. Topical glyceryl trinitrate (GTN) reduced pain on day 7 (7 studies, 485 participants), with a mean difference and 95% confidence interval (MD, 95% CI) of −1.34 (−2.31; −0.37), I2 = 91%. Diltiazem reduced pain on day 3 on the VAS, and the MD was −2.75 (−398; −1.51) shown in five studies (n = 227). Botulinum toxin reduced pain on day 7, in four studies with 178 participants, MD −1.43 (−2.50; −0.35) I2 = 62%. The addition of Lateral Internal Sphincterotomy to haemorrhoidectomy reduced pain on day 2 in three studies with 275 participants, MD of −2.13 (−3.49; −0.77) I2 = 92%. The results were limited by high heterogeneity and risk of bias. Conclusion Evidence suggests that lateral sphincterotomy, administration of botulinum toxin and the application of topical diltiazem or GTN can reduce post-operative pain after haemorrhoidectomy. Lateral sphincterotomy should not be routinely used due to the risk of incontinence.

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The Role of Lateral Internal Sphincterotomy in Haemorrhoidectomy: A Study in a Tertiary Care Center

Cited by 6 publications

References 13 publications

Does Lateral Internal Sphincterotomy Impact the Outcome of Haemorrhoidectomy

Does Lateral Internal Sphincterotomy Impact the Outcome of Haemorrhoidectomy

Strategies to Reduce Post-Hemorrhoidectomy Pain: A Systematic Review

Can Targeting Sphincter Spasm Reduce Post‐Haemorrhoidectomy Pain? A Systematic Review and Meta‐Analysis

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