Lateral internal sphincterotomy together with haemorrhoidectomy for treatment of haemorrhoids: a randomised prospective study

Objective: To investigate anorectal manometric findings in patients with ha emorrhoids and to evaluate the clinical effects and physiological consequen ces of adding a lateral internal sphincterotomy (LIS) to haemorrhoidectomy. Design: Randomised prospective study. Setting: Teaching hospital, Naples. Patients: 48 consecutive patients with prolapsed piles who had anorectal ma nometry; 10 healthy volunteers served as controls. Interventions: Resting and squeeze pressures, sphincter length and rectoana l inhibitory reflex were recorded. 6 patients were excluded because anal pr essures were not raised, so 42 patients were randomised. 22 patients had ha emorrhoidectomy plus LIS; and 20 had haemorrhoidectomy alone. Main outcome measures: Morbidity, continence, and anorectal manometry. Results: Sphincter anomalies were found in 87.5% (n = 42) of patients. Haem orrhoidectomy alone did not affect anal pressures, which returned to the no rmal ranges after sphincterotomy. Those who had LIS did better postoperativ ely than those who had did not. 4 patients who did not have a sphincterotom y developed anal strictures. No patient who had LIS developed incontinence of faeces. Conclusions: High anal pressures are common in patients with haemorrhoids s uggesting that they may have a pathogenetic role; anorectal manometry is us eful in the investigation of anal pressure patterns; and when indicated, la teral sphincterotomy avoids pain, urinary retention, and stenosis, and is s afe.