Impact of hemorrhoidectomy with lateral internal sphincterotomy on resting anal pressure in grade III and IV haemorrhoids with elevated anal pressure (>90 mmHg): a prospective observational study
DOI:
https://doi.org/10.18203/2320-6012.ijrms20262646Keywords:
Anal spasm, Hemorrhoids, Lateral internal sphincterotomy, Open hemorrhoidectomy, Stapler hemorrhoidectomyAbstract
Background: Grade III and IV hemorrhoids commonly present with pain, bleeding and prolapse, often associated with elevated resting anal pressure. This study assessed postoperative changes in anal pressure and their relationship with disease grade, surgical procedure and outcomes.
Methods: This 18-month prospective study included 79 patients with Grade III–IV hemorrhoids and elevated resting anal pressure, evaluating postoperative pressure changes and their association with symptoms, disease severity and hemorrhoidectomy type.
Results: The mean age was 44.6±12.4 years; 67.1% were male, with most patients aged 31–40 years. Perianal pain was present in all patients, followed by bleeding (n=44) and prolapse (n=34). Grade III and IV hemorrhoids were seen in 43% (n=34) and 57% (n=45), respectively; 53.2% underwent open and 46.8% stapler hemorrhoidectomy. Preoperative VAS scores were similar between groups (p=0.898). Median VAS significantly decreased from 6 (IQR 5–7) preoperatively to 2 (IQR 1–2) on POD1 and 1 (IQR 0–1) on POD7 (p<0.001). On POD1, 84.8% had mild pain, 11.4% no pain and 3.8% moderate pain; by POD7, 36.7% were pain-free and 63.3% had mild pain. Complications included bleeding (n=17), urinary retention (n=12) and faecal incontinence (n=3). Mean resting anal pressure decreased from 122.9±7.50 mmHg preoperatively to 83.4±7.42 mmHg at 1 week and 90.9±7.63 mmHg at 2 months (p<0.001), with recurrence in only two stapler hemorrhoidectomy patients at 3 months.
Conclusions: Grade III–IV hemorrhoid surgery significantly reduces symptoms and resting anal pressure, with both open and stapler hemorrhoidectomy showing similar efficacy, low complications and minimal recurrence.
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References
Johanson JF, Sonnenberg A. The prevalence of haemorrhoids and chronic constipation. An epidemiologic study. Gastroenterology. 1990;98(2):380–6. DOI: https://doi.org/10.1016/0016-5085(90)90828-O
Sun Z, Migaly J. Review of hemorrhoid disease: presentation and management. Clin Colon Rectal Surg. 2016;29(1):22-9. DOI: https://doi.org/10.1055/s-0035-1568144
Riss S, Weiser FA, Schwameis K, Riss T, Mittlböck M, Steiner G, et al. The prevalence of hemorrhoids in adults. Int J Colorectal Dis. 2012;27(2):215-20. DOI: https://doi.org/10.1007/s00384-011-1316-3
Feingold DL. Current Therapy in Colon and Rectal Surgery, 2nd ed. Ann Surg. 2007;246(2):337. DOI: https://doi.org/10.1097/SLA.0b013e31811ea9eb
Farook A, Periasamy A, Arvind S, Kannan I. Study on prevalence and surgical management of haemorrhoids in a tertiary care teaching hospital in a rural area. Int Surg J. 2018;5(4):1263–6. DOI: https://doi.org/10.18203/2349-2902.isj20181033
Ravindranath GG, Rahul BG. Prevalence and risk factors of hemorrhoids: a study in a semi-urban centre. Int Surg J. 2018;5(2):496–9. DOI: https://doi.org/10.18203/2349-2902.isj20180339
Dong Wan Kang, Byoung Soo Kim, Ji Hun Kim, Kyong Rae Kim, Gyong Suk Kang. A comparative study of conventional hemorrhoidectomy vs. anoderm-preserving partial hemorrhoidectomy after banana-clip ligation for grade iii-iv hemorrhoids: retrospective study. Arc Clin Exp Surg. 2024;13(6):1-9.
Khalid S, Laghari ZH, Rafiq MK, Khan G, Manzoor H, Biju SP, et al. A comparative analysis of gastrointestinal recovery and pain management outcomes in stapled versus open hemorrhoidectomy: a meta-analysis. Cureus. 2025;17(2):79305. DOI: https://doi.org/10.7759/cureus.79305
Moldovan C, Rusu E, Cochior D, Toba ME, Mocanu H, Adam R, et al. Ten-year multicentric retrospective analysis regarding postoperative complications and impact of comorbidities in hemorrhoidal surgery with literature review. World J Clin Cases. 2023;11(2):366–84. DOI: https://doi.org/10.12998/wjcc.v11.i2.366
Hetzer FH, Demartines N, Handschin AE, Clavien PA. Stapled vs excision hemorrhoidectomy: long-term results of a prospective randomized trial. Arch Surg Chic Ill 1960. 2002;137(3):337–40. DOI: https://doi.org/10.1001/archsurg.137.3.337
Nisar PJ, Acheson AG, Neal KR, Scholefield JH. Stapled hemorrhoidopexy compared with conventional hemorrhoidectomy: systematic review of randomized, controlled trials. Dis Colon Rectum. 2004;47(11):1837–45. DOI: https://doi.org/10.1007/s10350-004-0679-8
Wang Y, Dai G, Jiang L, Liao S. The incidence of regression after the non-surgical treatment of symptomatic lumbar disc herniation: a systematic review and meta-analysis. BMC Musculoskelet Disord. 2020;21(1):530. DOI: https://doi.org/10.1186/s12891-020-03548-z
Vijayaraghavalu S, Prasad RG, Rajkumar S. The role of lateral internal sphincterotomy in haemorrhoidectomy: a study in a tertiary care center. Cureus. 2021;13(6):15630. DOI: https://doi.org/10.7759/cureus.15630
Emilio M, Barbara T, Maria TS. Anorectal manometric changes after standard and stapled hemorrhoidectomy. J Pelvic Med Surg. 2008;14(1):51-5. DOI: https://doi.org/10.1097/SPV.0b013e318163ad21
Alper D, Ram E, Stein G Y, Dreznik Z. Resting anal pressure following hemorrhoidectomy and lateral sphincterotomy. Dis Colon Rectum. 2005;48(11):2080-4. DOI: https://doi.org/10.1007/s10350-005-0165-y
Sutherland LM, Burchard AK, Matsuda K, Sweeney JL, Bokey EL, Childs PA, et al. A systematic review of stapled hemorrhoidectomy. Arch Surg Chic Ill. 2002;137(12):1395–406. DOI: https://doi.org/10.1001/archsurg.137.12.1395
Sachin ID, Muruganathan OP. Stapled hemorrhoidopexy versus open hemorrhoidectomy: a comparative study of short term results. Int Surg J. 2017;4(2):472–8. DOI: https://doi.org/10.18203/2349-2902.isj20164791
Liu YH, Lin TC, Chen CY, Pu TW. Modified stapled hemorrhoidopexy for lower postoperative stenosis: A five-year experience. World J Gastrointest Surg. 2024;16(9):2787–95 DOI: https://doi.org/10.4240/wjgs.v16.i9.2787
Hong YK, Choi YJ, Kang JG. Correlation of Histopathology With Anorectal Manometry Following Stapled Hemorrhoidopexy. Ann Coloproctology. 2013;29(5):198–204. DOI: https://doi.org/10.3393/ac.2013.29.5.198
Mohammed S, Balachandran KJ, Vineed S, Chisthi MM. Stapled versus open haemorrhoidectomy: a prospective study. Int Surg J. 2020;7(11):3740–4. DOI: https://doi.org/10.18203/2349-2902.isj20204682
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