EFFICACY AND SAFETY OF HAEMORRHIDECTOMY ALONE AND HAEMORRHOIDECTOMY PLUS LATERAL INTERNAL SPHINCTEROTOMY FOR MANAGEMENT OF 3RD AND 4TH DEGREE HEMORRHOIDS

Abstract

Objectives: To compare the efficacy and complications of Haemorrhoidectomy alone and Haemorrhoidectomy plus lateral internal sphicterotomy (LIS) for the treatment of 3rd and 4th degree Haemorrhoids among middle-aged patients.

Study Design: Quasi experimental study.

Place and Duration of Study: Combined Military Hospital, Quetta from Mar 2010 to Feb 2011.

Methodology: A total of 60 patients of 3O and 4O Haemorrhoids, were randomly divided into two groups ‘A’ and ‘B’ with 30 patients in each group. Group ‘A’ and ‘B’ were subjected to Haemorrhoidectomy alone and Haemorr-hoidectomy plus LIS respectively. The outcome measures were relief of symptoms, recurrence rate and complications.

Results: Important immediate complication was postoperative pain in group ‘A’. 33.3% had moderate pain and 26.7% had severe pain within 24 hours of procedure whereas in group ‘B’ 13.3% patients had moderate pain and 10% had severe pain (p-value 0.002). Postoperative bleeding and acute urinary retention were not major complications in both groups. Flatus and faecal incontinence was major problem in group ‘B’ at 1st postoperative day and 1st week with 30% and 16.7% cases respectively. After 2 weeks, there was significant improvement in flatus 10% and faecal incontinence 3.3% in group ‘B’. At 6 months, only 3.3% in group ‘B’ had residual flatus incontinence. Anal stenosis was present in 13.3% patients in group ‘A’ as compared to none in group ‘B’ (p-value 0.043). On anoproctoscopy at 6 months, early recurrent/secondary haemorrhoids were seen in 23.3% patients in group ‘A’ and 3.3% in group ‘B’ (p-value 0.031). Ten percent patients from group ‘A’ presented with bleeding secondary haemorrhoids before 6 months (p-value 0.083).

Conclusion: The Haemorrhoidectomy plus LIS was found a recommended procedure in relatively younger patients of 3O and/or 4O haemorrhoids with good anal tone on digital rectal examination.