A Prospective Interventional Study of Outcome of Internal Sphincterotomy in Closed Haemorrhoidectomy.

ABSTRACT

Haemorrhoids are nowadays a very common anorectal disease in the community. It may be attributed to increased consumption of more refined and junk food by the present generation of people. We have been seeing symptomatic haemorrhoids as early as late teenagers, and early 20's. Well, there are plenty of treatment options available, among them, in our hospital we have been doing Ferguson's closed haemorrhoidectomy, but pain and urinary retention are frequently seen and sometimes troublesome requiring removal of per-anal pack overnight/Foley’s catheterization. And also, in those patients with tight sphincters, because of straining to pass the stools for the first time, the wound margins used to give away, converting into an open haemorrhoidectomy. Aim of this study was to assess the effect of sphincterotomy in patients undergoing closed haemorrhoidectomy, in terms of immediate post-operative pain and urinary retention.METHODSPatients who came with symptomatic haemorrhoids to our hospital during the period January 2018 to August 2019 were assessed and patients requiring haemorrhoidectomy were included in the study according to inclusion and exclusion criteria. Patients included in the study were randomly divided into 2 groups (without/with sphincterotomy) till target of 50 was achieved. Post-operative outcomes of pain and incidence of urinary retention was compared among the 2 groups.RESULTSOn analysing the data regarding severity of pain and incidence of urinary retention between the 2 groups, there was significant difference (p value <0.001) in perceiving pain on all the days of assessment, and incidence of urinary retention was significantly low in sphincterotomy group (p value 0.001).CONCLUSIONSDoing internal sphincterotomy at the base of haemorrhoidectomy wound significantly reduces the immediate post-operative pain and urinary retention following closed haemorrhoidectomy. So, when sphincter tone is high, it's better and safer to do sphincterotomy to alleviate immediate post-operative pain and urinary retention.