Hemorrhoidectomy Only Versus Hemorrhoidectomy With Lateral Internal Sphincterotomy

The Effect of Lateral Internal Sphincterotomy During Hemorrhoidectomy ,a Randomized Clinical Trial.

The aim of this study was to access the comparison of pain and complications after hemorrhoidectomy with or without lateral sphincterotomy.

Hemorrhoids arise from congestion of anal cushions and characteristically lie in the 3, 7 and 11 O clock positions (with the patient in lithotomy position) . The most common complication of open hemorrhoidectomy is postoperative pain caused by spasm of the internal sphincter . Lateral internal sphincterotomy is one good technique. It reduces pain by reducing spasm of internal anal sphincter which is the main cause of pain . The addition of lateral internal sphincterotomy to haemorrhoidectomy resulted in generally lower postoperative anal pressures . The long-term outcomes, which included anal stenosis and anal fissure, were significantly lower after lateral internal sphincterotomy . patients with recurrence of hemorrhoids, severe pain, prolonged constipation, or anyone with high sphincter tonicity in the digital rectal examination would be a candidate for manometric evaluation of anal canal pressure. These patients with high analcanal pressure confirmed with manometry might receive internal sphincterotomy plus hemorrhoid-ectomy .

Inclusion Criteria:

1. Surgically fit according to ASA.
2. Cases with hemorrhoids Grade ll& III & IV.
3. Age between (18-60).

Exclusion Criteria:

1. Age less than 18 years old.
2. Complete rectal prolapse.
3. Grade I hemorrhoids.