Usefulness of Lateral Internal Sphincterotomy in Reducing Postoperative Pain after Open Hemorrhoidectomy

Abstract

The aim of the present study was to evaluate the effect of lateral internal sphincterotomy on pain after open hemorrhoidectomy. From 1998 to 2003, seventy-eight (78) patients with fourth-degree hemorrhoids were included in this prospective randomized trial. The patients were randomized into two equal groups of 39 patients. Patients from group I underwent Milligan-Morgan hemorrhoidectomy. Patients from group II, quite apart from Milligan-Morgan hemorrhoidectomy, underwent lateral internal sphincterotomy up to the dentate line, in the left hemorrhoidectomy wound. One surgeon from the Department, who did not know to which group the patients belonged, evaluated the postoperative course in all the patients. After the first bowel movement, there were three (7.7%) patients who did not experience any pain in the internal sphincterotomy group, while in the non-internal sphincterotomy group all patients experienced mild or moderate pain. There were also more patients who experienced excruciating pain in the non-internal sphincterotomy group than in the internal sphincterotomy group (25 vs. 18); these differences were statistically significant (p = 0.034). There was no significant difference in the Wexner Incontinence Scale between the groups (p = 0.228). The addition of lateral internal sphincterotomy to open hemorrhoidectomy seems to have a positive effect on reducing postoperative pain in a few patients, without affecting the postoperative complications rate.

Pudendal nerve block versus local anesthesia for harmonic scalpel hemorrhoidectomy: a prospective randomized study

“…Pudendal nerve block is superior to simple perianal block in terms of postoperative pain and decreased length of hospital stay in a statistically significant manner while no differences were observed regarding complication's incidence [5][6][7][8].…”

Ligasure™ Precise vs. Conventional Diathermy for Milligan-Morgan Hemorrhoidectomy: A Prospective, Randomized, Multicenter Trial

“…1,13 However, the severe and prolonged postoperative pain produced by the hemorrhoidal excision has always been a cause of major concern for both surgeons and patients and several technical variations have been introduced to minimize patients' discomfort. [14][15][16] The use of radiofrequency energy instead of diathermy in hemorrhoidal excision was first described in 2001 17 and since then several randomized, clinical trials have been performed to compare Ligasure™ hemorrhoidectomy with conventional diathermy, with Ferguson's closed hemorrhoidectomy, 18,19 with Parks' hemorrhoidectomy, 20 and with stapled hemorrhoidopexy. 21,22 In the five randomized studies comparing the conventional diathermy technique with Ligasure™ excision, there is no univocal evidence that the use of radiofrequency excision may have clear benefits over CD, contributing to create some uncertainty among coloproctologists, particularly in times of restriction of government funds for the national health system.…”

Prospective clinical trial comparing sphincterotomy, nitroglycerin ointment and xylocaine/lactulose combination for the treatment of anal fissure

“…Nitroglycerin, as an exogenous donor of NO, relaxes the internal anal sphincter and improves the blood supply leading to relief of the symptoms and healing in the majority of cases [1][2][3][4][5][6][7]. According to Bailey et al [1], pain relief in patients with anal fissure is dose dependent.…”