Hemorrhoidectomy and sphincterotomy

Asfar, Sami; Juma, Talib; Ala-Edeen, Tareef

doi:10.1007/bf02552543

Cited by 44 publications

(7 citation statements)

References 13 publications

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“…26 Open haemorrhoidectomy, according to the results of a study by Ascanelli, is linked to higher levels of postoperative pain. 27 The pain and risk of sequelae after haemorrhoidectomy were found to be greatly reduced when sphincterotomy was performed routinely through one of the haemorrhoidectomy sites, as reported in a study by Sami et al 28 Galizia discovered in a study that doing a lateral internal sphincterotomy in conjunction with a haemorrhoidectomy greatly improves the postoperative course and is safe to do. 29 According to research conducted by Diana C. et al, conventional haemorrhoidectomy without LIS is linked to lengthier periods of postoperative discomfort and slower rates of functional recovery.…”

Section: Discussionmentioning

confidence: 92%

Comparison of Outcome in Unilateral and Bilateral Sphinctorotomy in Patients of Haemorrhoidectomy

Rehman¹,

Rana²,

Liaquat³

et al. 2023

PJMHS

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The anal canal is the site of the dilated veins known as haemorrhoids. They're essential for achieving and maintaining complete continence. In the anal canal, they can be either internal or external. Haemorrhoids can cause pain, pruritis, mucous discharge, mucosal prolapse, bleeding (which is often painless), and brilliant red haemorrhage. 2 There are four different types of haemorrhoids, ranging from first degree (just bleeding) to fourth degree (prolapse and stay reduced on reduction) (permanently prolapsed).3 Even though every case of haemorrhoids bleeds, there are different categories based on how far the haemorrhoids have prolapsed. Only when things get complicated do you see any signs. 4 Objective and Methodology: This research aims to compare the rates of pain experienced by patients after undergoing haemorrhoidectomy, lateral internal sphincterotomy, and bilateral internal sphincterotomy. A Randomized Controlled Trial (RCT) study design was used for this investigation. The investigation took place at the Surgery Department of Allied Hospital in Faisalabad (March to September 2021). In all, 140 patients aged 25-65 with severe haemorrhoids (grades III and IV) were chosen. Any neurological deficiency or chronic pain syndrome, renal disease, or bleeding disorders, as well as patients with recurring haemorrhoids or other anorectal pathology (fistula in ano, anal fissures, etc.), were not included in the study. Hemorrhoidectomy with bilateral internal sphincterotomy (Group BL) and hemorrhoidectomy with lateral internal sphincterotomy (Group UL) were performed on patients. After 24 postoperative hours, all patients were evaluated for postoperative pain. Results: Patients in Group BL had a mean age of 45.36 10.33 years, whereas those in Group UL had a mean age of 43.94 10.22 years. A whopping 76 (54.29%) of the patients fell within the 25-45-year-old age range. The ratio of male to female patients was 2.1:1, with 95 males (67.86%) and 45 females (32.14%) in a total of 140 patients. Pain was experienced by 4 (5.71%) of my patients following haemorrhoidectomy with bilateral internal sphincterotomy and by 25 (35.71%) of my patients following haemorrhoidectomy with lateral internal sphincterotomy (p 0.0001). Conclusion: Patients undergoing hemorrhoidectomy were less likely to experience postoperative pain if bilateral internal sphincterotomy was performed. Keywords: Haemorrhoids, internal sphincterotomy, post-operative pain.

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Section: Discussionmentioning

confidence: 92%

Comparison of Outcome in Unilateral and Bilateral Sphinctorotomy in Patients of Haemorrhoidectomy

Rehman¹,

Rana²,

Liaquat³

et al. 2023

PJMHS

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“…Anal incontinence after KSL was prevented by taking following precautions: digital dilatation of only six (3+3) fingers was done by applying gentle, steady and continuous pressure in all directions and making circular finger movements for about 10 min,[89] internal anal sphincter was carefully prevented from being injured or included in Kshar Sutra ligature, sphincterotomy was not performed in any case,[13] wide retractors like Park's retractor or Ferguson's retractor were not used during surgery[14] and patients with history of obstetric anal trauma and neuropathic irritable bowel syndrome were excluded from the study.…”

Section: Discussionmentioning

confidence: 99%

“…The hemorrhoidal masses and their positions were identified by a thorough proctoscopic examination. Gentle digital anal stretching of no more than six (3+3) fingers (Recamier / Maisonneuve procedure)[89] was done. Intracanal packing was given to avoid soiling during operation.…”

Section: Methodsmentioning

confidence: 99%

A comparative study of Barron′s rubber band ligation with Kshar Sutra ligation in hemorrhoids

Singh¹,

Arya²,

Minhas³

et al. 2010

Int J Ayurveda Res

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Despite a long medical history of identification and treatment, hemorrhoids still pose a challenge to the medical fraternity in terms of finding satisfactory cure of the disease. In this study, Kshar Sutra Ligation (KSL), a modality of treatment described in Ayurveda, was compared with Barron's Rubber Band Ligation (RBL) for grade II and grade III hemorrhoids. This study was conducted in 20 adult patients of either sex with grade II and grade III hemorrhoids at two different hospitals. Patients were randomly allotted to two groups of 10 patients each. Group I patients underwent RBL, whereas patients of group II underwent KSL. Guggul-based Apamarga Kshar Sutra was prepared according to the principles laid down in ancient Ayurvedic texts and methodology standardized by IIIM, Jammu and CDRI, Lucknow. Comparative assessment of RBL and KSL was done according to 16 criteria. Although the two procedures were compared on 15 criteria, treatment outcome of grade II and grade III hemorrhoids was decided chiefly on the basis of patient satisfaction index (subjective criterion) and ability of each procedure to deal with prolapse of internal hemorrhoidal masses (objective criterion): Findings in each case were recorded over a follow-up of four weeks (postoperative days 1, 3, 7, 15 and 30). Statistical analysis was done using Student's t test for parametric data and Chi square test & Mann-Whitney test for non-parametric data. P < 0.05 was considered significant. RBL had the advantages of being an OPD procedure requiring no anesthesia and was attended by significantly lesser postoperative recumbency (P < 0.001 ) and significantly lesser pain (P < 0.005 on day 1) as compared to KSL. However, Group II (KSL) scored better in terms of treatment outcome. In Group II, there was significantly high (P < 0.05) patient satisfaction index as compared to Group I. Group II reported 100% 'cure' (absence of hemorrhoidal masses even on proctoscopy) of internal hemorrhoidal prolapse as against 80% in Group I (RBL); however, this difference was statistically insignificant (P > 0.05). Both the groups were comparable statistically on all other grounds. Kshar Sutra Ligation is a useful form of treatment for Grades II and III internal hemorrhoids.

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“…Though we have advocated routine sphincterotomy of the internal sphincter to reduce post‐hemorrhoidectomy pain [8] which was confirmed in a recent literature review [9], we did not practice routine sphincterotomy in this group of patients because of lack of information about details of the previous procedures on the region and for fear of damaging the sphincter in case it was cut previously. Only in 6 patients, the internal sphincter was fibrotic within the operative field, and it was partially incised to facilitate tissue mobilization.…”

Section: Methodsmentioning

confidence: 99%