Effect of Lateral Anal Sphincterotomy in Patients Undergoing Milligan-Morgan Hemorrhoidectomy at a Tertiary Care Hospital

Abstract

Background: Milligan-Morgan (MM) hemorrhoidectomy is associated with postoperative pain, bowel delay, and complications. Lateral internal sphincterotomy (LIS) can decrease sphincter spasm and enhance the recovery. In this paper, the authors assessed the impact of adding LIS to MM hemorrhoidectomy on postoperative outcomes.
Methods: The study was a quasi-experimental study of 60 patients who underwent MM hemorrhoidectomy (Group A (MM only, n = 30) and Group B (MM + LIS, n = 30). The Visual Analog Scale (VAS) was used to measure postoperative pain at 6 h, 24, day 3, day 7, and day 14. Other findings were included in time to first bowel movement, hospital, Wexner incontinence, and postoperative complications. The t-tests and chi-square tests were used for statistical analysis.
Results: The patients of the MM + LIS group had significantly lower pain scores (p <0.001) at all-time intervals, earlier first bowel movement (25.6 + 0.72 h vs. 30.6 + 1.43 h, p = 0.001), and reduced hospital stay (2.0 + 0.0 days vs. 2.93 + 0.25 days, p = 0.001) than the patients of the MM alone group. There were also decreased postoperative complications, including urinary retention, postoperative bleeding requiring correction, and delayed wound healing. Wexner scores for incontinence were not significantly different between the two groups. 
Conclusion: LIS is added to MM hemorrhoidectomy, and it has a significant effect of reducing postoperative pain, early bowel movement, short hospitalization, and complications, especially in younger and healthier patients. It is important to carefully select patients and counsel them on the risk of incontinence. These results suggest that LIS is useful as a supplement to standard hemorrhoidectomy.