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[When to combine internal sphincterotomy with hemorrhoidectomy]

P Lolli1, D Piccinelli, S Girardi

  • 1Dipartimento di Scienze Chirurgiche, Università di Verona.

Annali Italiani Di Chirurgia
|November 1, 1995
PubMed
Summary

Hemorrhoidectomy patients with high anal resting pressure (TBS) benefit from combined sphincterotomy. Regulated lateral internal sphincterotomy (SILR) alongside hemorrhoidectomy normalizes TBS in selected cases, improving outcomes.

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Area of Science:

  • Colorectal Surgery
  • Physiology
  • Gastroenterology

Context:

  • Hemorrhoidectomy is a common surgical procedure for hemorrhoidal disease.
  • High anal resting pressure (TBS) can complicate hemorrhoidectomy outcomes.
  • Preoperative manometry is used to assess anal sphincter function.

Purpose:

  • To evaluate the efficacy of combining regulated lateral internal sphincterotomy (SILR) with hemorrhoidectomy in patients with high anal resting pressure.
  • To assess the impact of SILR on anal resting pressure post-hemorrhoidectomy.

Summary:

  • 396 patients underwent hemorrhoidectomy (Parks or Milligan-Morgan technique).
  • 158 patients (39.9%) exhibited high anal resting pressure (TBS) and underwent additional SILR.
  • Postoperative manometry at two months showed similar TBS values in both groups, indicating SILR's effectiveness in normalizing pressure.

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Impact:

  • Suggests that combining SILR with hemorrhoidectomy is crucial for achieving normal anal resting pressure in manometrically selected patients.
  • Highlights the importance of preoperative manometry for patient selection in hemorrhoidectomy.
  • Offers a refined surgical approach to improve outcomes for patients with high anal resting pressure.