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Preservation of anal sphincter function after hemorrhoidectomy under local anesthesia
1Department of Surgery, Taipei Veterans General Hospital, and National Yang-Ming University School of Medicine, Taiwan, ROC. TSCRS@vghtpe.gov.tw
Background:
This is a prospective study designed to confirm a simple, effective method of hemorrhoidectomy that can be accomplished by simple local anesthesia with good preservation of anal sphincter function both clinically and manometrically.
Methods:
Eighty consecutive patients with prolapsed mixed hemorrhoids were operated with standard closed hemorrhoidectomy under local anesthesia. Pre- and post-operative assessments of anal continent function and anorectal manometry were performed. Maximal basal pressure (MBP), maximal contraction pressure (MCP), squeeze pressure (SP), rectoanal inhibitory reflex (RAIR), functional length (FL), volumes at the first sensation of rectal fullness (V sense), urge of defecation (V urge), and intolerance (V max.) were measured. The pre-and post-operative data were compared with two tailed paired Student t test. Statistical significance was considered asp-value less than 0.05.
Results:
All 80 patients were completely followed up and studied. No patient had any degree of anal incontinence before and 6 months after hemorrhoidectomy. There was significant change in V sense and V urge after operation. However, MBP, MCP, SP, FL, RAIR, and V max. remained unchanged.
Conclusions:
Standard closed hemorrhoidectomy supplemented with appropriate submucosal dissection under adequate local anesthesia is simple and effective for the treatment of prolapsed hemorrhoids. The function of anal sphincter, both clinically and manometrically, can be well preserved.