Excisional hemorrhoidal surgery and its effect on anal continence

Area of Science:

• Colorectal Surgery
• Gastroenterology
• Anorectal Physiology

Background:

• Hemorrhoids are a common condition, often treated with Milligan-Morgan hemorrhoidectomy.
• Anal cushions, integral to anorectal function, may be affected by hemorrhoidectomy.
• Assessing the impact on anal continence is crucial for patient outcomes.

Purpose of the Study:

• To evaluate the effect of Milligan-Morgan hemorrhoidectomy on anal continence.
• To determine if anal cushion integrity influences postoperative continence.
• To identify patient subgroups at risk for continence deterioration after surgery.

Main Methods:

• Seventy-six patients with symptomatic third- and fourth-degree hemorrhoids underwent Milligan-Morgan hemorrhoidectomy.
• Anal continence was assessed pre- and post-operatively using the Wexner score and a liquid continence test.
• Patients were stratified into three groups based on preoperative liquid retention volumes.

Main Results:

• Overall anal continence showed no significant change post-hemorrhoidectomy (P=0.057).
• Patients with lower preoperative liquid retention (Group A) demonstrated a significant decrease in continence post-surgery (P=0.003).
• No significant continence difference was observed in groups with higher preoperative retention (Group B and C).

Conclusions:

• Milligan-Morgan hemorrhoidectomy does not significantly impact overall anal continence.
• Patients with compromised preoperative continence may experience further deterioration after this procedure.
• Careful patient selection is advised, avoiding Milligan-Morgan hemorrhoidectomy in those with preoperative continence deficits.