|
Hemorrhoidectomy and its functional implication on the
internal anal sphincter- a long term manometric study
Edward Ram1, Dan Alper2,
Gideon Y. Stein2, Zeev Dreznik2
Department of surgery, Nazareth Hospital (1),
Division of General Surgery (2), Rabin Medical Center, Sackler
School of Medicine Tel-Aviv University, Israel
Hemorrhoid disease is the most
prevalent disorder of the anorectal region. It affects 4.4% of the western
population; one-third of these patients are symptomatic and
need treatment. The aim of this study was to evaluate sphincter function
following hemorrhoidectomy.
Method: Between
the years 2001-2003, 38 patients (22 females and 16 males) who underwent
hermorrhoidectomy were included in the study. All patients had
third- or fourth-degree symptomatic hemorrhoids. 12 healthy patients served
as controls.
Manometric studies were performed before
surgery and the anal resting pressure measurement was repeated
post-operatively at one, three, six and 12 months. The control group had 3
manometric evaluations 6 months apart. All the patients had a
manometric evaluation using a 6 channel perfusion catheter.
Results:
Baseline manometry measurement in the hemorrhoid group was significantly
higher than in the control group (108.4 ± 23 mmHg vs. 73 ± 5.9 mmHg,
p<0.0001). At 12 months follow-up, there was a significant decline in
pressure measurements as compared to baseline (103.6 ± 21.5 mmHg vs. 108.4
± 23 mmHg, p< 0.0001), but they still remained higher than in the
controls. Longer anal retraction (>20 min) resulted in higher
percentage of patients with pressure reduction of more than 5 mmHg (61% vs.
25%, p=0.025).
Conclusion: The
function of the internal anal sphincter is only temporarily disturbed but
eventually regains its strength gradually over one year. Longer anal
retraction results in a greater decline in manometric values after 12
months. Women had a significant lower anal resting pressure than men before
and after hemorrhoidectomy.
|