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Internal sphincterotomy with hemorrhoidectomy does not relieve pain: a prospective, randomized study
1Milton S. Hershey Medical Center, College of Medicine, Pennsylvania State University, Hershey, PA, USA.
Insights
Internal sphincterotomy does not reduce pain after hemorrhoidectomy. This study found no significant difference in postoperative pain or continence issues between patients who underwent the procedure and those who did not.
Area of Science:
- Colorectal Surgery
- Surgical Outcomes
- Pain Management
Background:
- Post-hemorrhoidectomy pain is a significant challenge.
- The internal sphincter's role in pain perception is debated.
- Current pain management strategies for hemorrhoidectomy are varied.
Purpose of the Study:
- To evaluate the impact of internal sphincterotomy on pain after closed hemorrhoidectomy.
- To compare patient discomfort levels with and without sphincterotomy.
- To investigate the origin of post-hemorrhoidectomy pain.
Main Methods:
- Prospective, randomized study design.
- 42 patients undergoing excisional hemorrhoidectomy were included.
- Patients were randomized to receive either a closed hemorrhoidectomy or a closed hemorrhoidectomy with internal sphincterotomy.
Main Results:
- No statistical difference in postoperative pain was observed at 4 hours, after the first bowel movement, or 4 days post-surgery.
- No significant variations in postoperative bleeding, urinary retention, or return to work.
- Both groups reported similar difficulties with gas control and soiling.
Conclusions:
- Internal sphincterotomy does not appear to alleviate pain following hemorrhoidectomy.
- The procedure did not improve continence outcomes compared to standard hemorrhoidectomy.
- Further research may be needed to identify effective pain reduction methods.
Purpose:
Pain after hemorrhoidectomy is universal. Several attempts have been made to reduce or alleviate the pain after excisional hemorrhoidectomy. The origin of pain is undetermined. Current theories propose that the pain is mediated through the internal sphincter. This prospective, randomized study was performed to assess the degree of discomfort in patients with and without a sphincterotomy when performing a closed hemorrhoidectomy.
Methods:
Between December 1999 and September 2001, 42 patients (22 males), median age 52 (range, 30-80) years, who underwent excisional hemorrhoidectomy were randomly chosen to have an internal sphincterotomy in the base of the left lateral wound.
Results:
Thirty-nine patients were available for the study. Parameters elicited in the study were pain, postoperative bleeding, urinary retention, impairment of continence by day and by night, and day the patient returned to work. There was no statistical difference in the postoperative pain in each of the two categories at four hours after surgery, after the first bowel movement, or four days after surgery.
Conclusions:
Results showed no difference in the perception of pain after hemorrhoidectomy in patients who had an internal sphincterotomy compared with those who did not. Both groups were equally likely to have difficulty with control of gas and soiling.
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