Can Targeting Sphincter Spasm Reduce Post-Haemorrhoidectomy Pain? A Systematic Review and Meta-Analysis

Area of Science:

• Gastroenterology and surgical research.
• Investigating pain management strategies in colorectal surgery.

Background:

• Post-haemorrhoidectomy pain is significant and often linked to internal anal sphincter spasm.
• This study evaluates interventions aimed at reducing sphincter spasm to alleviate post-operative pain.

Approach:

• A systematic review and meta-analysis adhering to PRISMA guidelines.
• Searched Medline, EMBASE, and CENTRAL databases for relevant randomized controlled trials (RCTs).
• Included RCTs comparing interventions for internal anal sphincter spasm post-haemorrhoidectomy, with pain on a visual analogue scale as the primary outcome.

Key Points:

• Topical glyceryl trinitrate (GTN), diltiazem, and botulinum toxin demonstrated pain reduction at various time points.
• Lateral internal sphincterotomy also reduced pain, but its routine use is cautioned against due to incontinence risks.
• High heterogeneity and risk of bias were noted limitations in the included studies.

Conclusions:

• Lateral sphincterotomy, botulinum toxin, topical diltiazem, and GTN are effective in reducing post-operative pain after haemorrhoidectomy.
• Caution is advised regarding routine lateral sphincterotomy due to potential incontinence.
• Further research may be needed to address heterogeneity and bias in existing evidence.