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<p>Postoperative pain (POP) remains a substantial concern following hemorrhoidectomy. This study evaluated whether adding lateral internal sphincterotomy (LIS) to standard hemorrhoidectomy reduces POP and improves clinical outcomes or not. This randomized open-label trial was conducted on 200 cases aged from 18 to 70 years, both sexes were included, and underwent hemorrhoidectomy (2nd, 3rd, and 4th degree hemorrhoids). Cases were divided into two equal groups: Group I: underwent hemorrhoidectomy with LIS and group II: underwent hemorrhoidectomy without LIS. Primary outcomes of the study were the degree of POP and incontience rate in both sexes. Postoperative anal pain scores were assessed at 48 h, one week, and four weeks. Incontinence rates were evaluated using Wexner incontinence scores at 48 h postoperatively. Median pain scores showed no substantial difference between groups at 48 h [4 (IQR: 3–6) vs. 5 (IQR: 3–6), <i>p</i> = 0.119], one week [2 (IQR: 1-2.25) vs. 2 (IQR: 1–3), <i>p</i> = 0.206], or four weeks [0 (IQR: 0–1) vs. 0 (IQR: 0–1), <i>p</i> = 0.231]. Analgesic requirements and bleeding rates showed no substantial difference between groups. However, incontinence rates were notably higher in the LIS group (31% versus 2%, <i>p</i> &lt; 0.001), with 24% experiencing flatus incontinence and 7% fecal soiling. Adding LIS to hemorrhoidectomy does not provide superior pain control while it may increasing incontinence risk. Standard hemorrhoidectomy without sphincterotomy remains the preferred surgical approach.</p><p><b>Trial registration:</b> registration of clinicaltrials.gov (ID: NCT06884774), (Date: 13/3/2025).</p>

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Effect of Lateral Internal Sphincterotomy on Postoperative Pain and Anal Continence After Hemorrhoidectomy: A Randomized Controlled Open-Label Trial

  • 期刊论文

  • 发表日期：

    2026年4月27日

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  • Waleed M. Abdelrahman,
  • Doaa Ali,
  • Abdelrahman M. Salah

摘要

Postoperative pain (POP) remains a substantial concern following hemorrhoidectomy. This study evaluated whether adding lateral internal sphincterotomy (LIS) to standard hemorrhoidectomy reduces POP and improves clinical outcomes or not. This randomized open-label trial was conducted on 200 cases aged from 18 to 70 years, both sexes were included, and underwent hemorrhoidectomy (2nd, 3rd, and 4th degree hemorrhoids). Cases were divided into two equal groups: Group I: underwent hemorrhoidectomy with LIS and group II: underwent hemorrhoidectomy without LIS. Primary outcomes of the study were the degree of POP and incontience rate in both sexes. Postoperative anal pain scores were assessed at 48 h, one week, and four weeks. Incontinence rates were evaluated using Wexner incontinence scores at 48 h postoperatively. Median pain scores showed no substantial difference between groups at 48 h [4 (IQR: 3–6) vs. 5 (IQR: 3–6), p = 0.119], one week [2 (IQR: 1-2.25) vs. 2 (IQR: 1–3), p = 0.206], or four weeks [0 (IQR: 0–1) vs. 0 (IQR: 0–1), p = 0.231]. Analgesic requirements and bleeding rates showed no substantial difference between groups. However, incontinence rates were notably higher in the LIS group (31% versus 2%, p < 0.001), with 24% experiencing flatus incontinence and 7% fecal soiling. Adding LIS to hemorrhoidectomy does not provide superior pain control while it may increasing incontinence risk. Standard hemorrhoidectomy without sphincterotomy remains the preferred surgical approach.

Trial registration: registration of clinicaltrials.gov (ID: NCT06884774), (Date: 13/3/2025).