Effect of lateral internal sphincterotomy in patients undergoing excisional hemorrhoidectomy

Abstract

Background:Excisional hemorrhoidectomy (EH) is the major surgical option for high-grade symptomatic hemorrhoids, but it has some shortcomings, especially postoperative pain. This study was performed to assess the effect of lateral internal sphincterotomy (LIS) in patients undergoing excisional hemorrhoidectomy.Methods:A systematic literature search (Medline, Embase, Cochrane Library, Science Citation Index, Science Direct, Springer Link, Ovid Journals, and EBSCO) was performed to identify all eligible articles. Randomized controlled trials (RCTs) published until July 7, 2017 comparing EH combined with LIS (experimental group) with EH only (control group) were eligible for inclusion. The primary outcome of interest was postoperative pain.Results:Ten RCTs involving 1560 patients were identified for inclusion. The pooled analysis revealed that patients undergoing EH and LIS were associated with lower pain score [standardized mean difference (SMD), −0.75; 95% confidence interval (CI), −1.14 to −0.36; z = 3.76; P = .0002] and resting anal pressure [odds ratio (OR), −17.19; 95% CI, −25.66 to −8.72; z = 3.98; P < .0001], and lower incidence of anal stricture (OR, 0.12; 95% CI, 0.03–0.53; z = 2.85; P = .004). However, the differences of urinary retention, bleeding and length of hospital stay were similar between the 2 methods.Conclusion:Our meta-analysis suggests that LIS effectively relieves postoperative pain and reduces patient's postoperative analgesic requirements. LIS also reduces the incidence of anal stenosis but increases the incidence of fecal incontinence.

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

“…We followed up our patients at six months and 24 months for anal fissure, anal stenosis, and bowel and gas incontinence. Patients developing anal stenosis usually have complaints of either anal pain, constipation, or bleeding [ 15 , 16 ]. Anal stenosis is believed to be reduced in LIS, whereas it is a rare serious complication of haemorrhoidectomy.…”

Role of Internal Sphincterotomy as an Adjunct to Open Haemorrhoidectomy for Management of Third- and Fourth Degree Haemorrhoids

“…Meta-analysis based on multiple trials, spanning over a period of decade, have proven the role of sphincterotomy in reducing post-operative pain and analgesic requirements. 14 In one local study, post-operative pain relief was present in twice as many patients having sphincterotomy while comparing with haemorrhoidectomy alone. 13 The reason for pain following haemorrhoidectomy is believed to be due to the increased anal pressure caused by the persistent spasm of the internal anal sphincter.…”

Worldwide Disease — Haemorrhoids. How Much Do We Know?

“…Commonly excision of haemorrhoidal tissue is performed within the first 48 h of symptoms of thrombosing. Complete excision of a haemorrhoid with associated skin is advised when incision and drainage are ineffective (Wang et al, 2018;Gardner et al, 2020).…”

“…Urinary retention, bleeding, fecal or flatus incontinence, perianal wetness, anal stenosis, and recurrence are complications demonstrated when using this technique (Kendirci et al, 2018). The severity of pain depends on the number of muscular and collagenous bundles excised, and the method commonly is safe for grades III to IV (Lohsiriwat, 2015;Wang et al, 2018).…”