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Randomized trial assessing anal sphincter injuries after stapled haemorrhoidectomy
Y H Ho1, F Seow-Choen, C Tsang
1Department of Colorectal Surgery, Singapore General Hospital, Outram Road, Singapore 169608. HoYH@sgh.gov.sg
The British Journal of Surgery
|October 31, 2001
Summary
Omitting the anal dilator in stapled hemorrhoidectomy (ND technique) reduces anal sphincter injury risk compared to the conventional dilator (DL technique). This leads to better long-term sphincter preservation without compromising patient outcomes.
Area of Science:
- Colorectal Surgery
- Surgical Innovation
- Anorectal Physiology
Background:
- Conventional stapled hemorrhoidectomy utilizes a large circular anal dilator (DL technique).
- This dilator may lead to anal sphincter injuries.
- This study investigates a non-dilator (ND) technique for improved sphincter preservation.
Purpose of the Study:
- To compare the efficacy and safety of stapled hemorrhoidectomy performed with (DL) versus without (ND) a large circular anal dilator.
- To assess the impact of the DL technique on anal sphincter integrity.
- To evaluate patient-reported outcomes and functional results.
Main Methods:
- Randomized controlled trial involving 58 patients with prolapsed irreducible hemorrhoids.
- Patients were assigned to either the DL (n=29) or ND (n=29) group.
- Preoperative and postoperative assessments included continence scoring, anorectal manometry, endoanal ultrasonography, pain scores, and quality of life measures up to 14 weeks.
Main Results:
- The DL technique was associated with significantly longer operative times (P=0.02).
- Internal anal sphincter fragmentation was observed up to 14 weeks post-DL (P=0.038), but not post-ND.
- No significant differences were found in continence, anal pressures, pain, satisfaction, quality of life, or time off work between the groups.
Conclusions:
- The use of a large circular anal dilator in stapled hemorrhoidectomy increases the risk of anal sphincter injury.
- This risk may have long-term implications, particularly with aging.
- Performing stapled hemorrhoidectomy without a dilator (ND technique) appears to offer comparable functional outcomes with improved sphincter preservation.