Role of Internal Sphincterotomy in the Treatment of Hemorrhoids: A Randomized Clinical Trial

Background: Anal canal dilatation and sphincterotomy have been recommended besides hemorrhoidectomy to overcome the anal pressures in the management of hemorrhoids. The aim of this study to compare internal sphincterotomy and hemorrhoidectomy with hemorrhoidectomy alone with respect to manometric and clinical measures. Methods: One hundred twenty patients with hemorrhoids were randomly assigned to receive either hemorrhoidectomy with sphincterotomy or hemorrhoidectomy alone. Anal canal pressures including mean squeeze pressure, maximal resting anal canal pressure, and mean resting anal canal pressure, were recorded by manometry before the operation. The patients were evaluated one week and two weeks after the operation clinically and three months later by manometry. Results: The patients were matched with respect to age, gender, and chief complaints. The mean±SD age of the patients in hemorrhoidectomy with sphincterotomy group (A) was 43.8±14 and in hemorrhoidectomy alone group (B) was 43.94±15 years. The male to female ratio was 1.1:1. One week after the operation, there was no statistically significant differences in the frequency of postoperative complications like pain and urinary incontinence between the two groups except for fecal incontinence which was more frequent in group A. After two weeks, the same results with an acceptable improvement in fecal incontinence in group A were observed. Three months after the operation, manometry showed considerable reduction in the mean resting anal canal pressure and maximal resting anal canal pressure in group A; the mean squeeze pressure did not have any changes in either group. Conclusion: We recommend sphincterotomy plus hemorrhoidectomy for patients with high anal canal pressure documented by manometry prior to the operation.