The sub-saharan experience of excisional haemorrhoidectomy with simultaneous lateral internal sphincterotomy

Elnaim, Abdel Latif Khalifa and Won, Michael Pak-Kai and Ang, Chin Wee and Sagap, Ismail (2021) The sub-saharan experience of excisional haemorrhoidectomy with simultaneous lateral internal sphincterotomy. Indian Journal Of Surgery, 83 (2). pp. 522-525. ISSN 0972-2068, DOI

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Milligan-Morgan haemorrhoidectomy (MMH) is still regarded as the standard excisional haemorrhoid procedure. In our centre, prophylactic lateral internal sphincterotomy (LIS) has been routinely performed simultaneously with MMH due to increased incidence of concurrent chronic anal fissure (CAF). We aimed to review our practice, the safety and feasibility of routine MMH+LIS among patients with or without CAF. A prospective observational study was conducted to examine the outcome of MMH + LIS in Kassala, Sudan, from 2015 to 2018. The short-term outcomes of patients undergoing MMH+LIS were compared between patients with or without CAF. There were 252 patients included in the study, with the median age of 33 (ranged 13-80), and 146 (57.94%) were male patients. Of these, 205 patients (81.3%) had third-degree prolapsed haemorrhoids, and 47 patients (18.7%) had fourth-degree prolapsed haemorrhoids, with 73 (29%) patients had a concurrent chronic anal fissure. There were no significant difference (p > 0.05) between the comparing groups with regard to the complications occurred, which were post-operative bleeding (n = 4, 1.6%), anal stenosis (n = 5, 1.98%), faecal incontinence (n = 2, 0.79%), chronic anal pain (n = 5, 1.98%), chronic anal discharge (n = 3, 1.19%), pruritus ani (n = 4, 1.58%) and obstructed defaecation symptoms (n = 4, 1.58%). The overall complication rates were 16/252 (6.3%). Patients without pre-existing CAF were significantly associated with increased post-operative pain (p < 0.0001) after LIS. Prophylactic LIS, along with MMH, is a safe strategy with reasonable desired short-term outcomes and low complication rates. Patients with pre-existing CAF gain better pain control having had concurrent LIS which ultimately justify the procedure.

Item Type: Article
Uncontrolled Keywords: Haemorrhoidectomy; Lateral internal sphincterotomy; Complications
Subjects: R Medicine > R Medicine (General) > Medical technology
R Medicine > RD Surgery
Divisions: Faculty of Medicine > Orthopaedic Surgey Department
Depositing User: Ms. Juhaida Abd Rahim
Date Deposited: 18 Apr 2022 03:10
Last Modified: 18 Apr 2022 03:10

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