Document Detail

Effect of hemorrhoidectomy on anorectal physiology.
MedLine Citation:
PMID:  19844729     Owner:  NLM     Status:  MEDLINE    
PURPOSE: The aim of this study was to determine whether overactivity of the anal sphincter in patients with hemorhhoids is primary or secondary and thus assess indication of lateral internal sphincterotomy to surgical treatment of hemorrhoids. Tonic contraction of the sphincter muscle in patients with advanced stages of hemorrhoids is considered by many authors as a primary cause, and therefore, they complete hemorrhoid surgery with lateral internal sphincteroomy. If hypertension of anal sphincter is secondary during hemorrhoid disease, lateral internal sphincterotomy is not indicated. Although examinations made immediately after sphincterotomy proved no changes of anal continence, certain sequelae of lateral internal sphincterotomy cannot be excluded and may later negatively affect patient's anal continence. PATIENTS AND METHODS: The prospective study comprised 385 patients treated in 2002-2006 by Hemoron or surgery according to Milligan-Morgan or Longo. Patients with history of another disease of the anal canal, radiotherapy of pelvis, Crohn's disease or ulcerous colitis were excluded. Manometry was performed before and after surgery at intervals of 1, 3, 6 and 12 months after operation using a perfusion flow method, six-channels catheter with radial arrangement of channel tips. RESULTS: In all three groups (Hemoron, sec. Milligan-Morgan, sec. Longo), there were 60-65% of patients with third degree hemorrhoids. Normal resting anal pressure before surgery was recorded in only 25% of men and 30% of women. Patients with advanced hemorrhoid degrees were found to have significant hypertension of the anal sphincter. The most significantly improved state of sphincter overactivity was observed after surgery according to Longo and application of Hemoron. After surgery, according to Milligan-Morgan, recovery of anal sphincter tension was the longest; even 6 months after operation, a mean increased resting anal pressure persisted (91-110 mmHg) in 25% of men and 19% of women. After 12 months, recovery of anal tension occurred in this group also--mean increased anal pressure was recorded in only three patients (1.67%). CONCLUSION: Overactivity of the anal sphincter in patients with hemorrhoids is secondary and according to our results. Hypertension of the sphincter muscle in patients with hemorrhoids is significantly increased in patients with advanced degrees of hemorrhoids. Therefore, it is not recommended to postpone surgery and indicate patients with advanced degrees of hemorrhoids to hemorrhoidectomy.
Kamil Vyslouzil; Pavel Zboril; Pavel Skalick?; Katherine Vom?ckov?
Related Documents :
19390759 - Sacral nerve terminal motor latency in patients with or without soiling more than 2 yea...
17432989 - A prospective evaluation of stapled haemorrhoidopexy/rectal mucosectomy in the manageme...
10932659 - Fissurectomy as a treatment for anal fissures in children.
17704969 - Does infliximab influence surgical morbidity of ileal pouch-anal anastomosis in patient...
7829009 - Longterm appraisal of the histological appearances of the ileal reservoir mucosa after ...
7926909 - Surgery for ulcerative colitis in the era of the pouch: the st mark's hospital experience.
991429 - Myocardial revascularization and mitral repair or replacement for mitral insufficiency ...
2028349 - Surgery for the wolff-parkinson-white syndrome. the groote schuur hospital experience.
10360309 - The ocular manifestations of congenital infection: a study of the early effect and long...
Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, Non-U.S. Gov't     Date:  2009-10-21
Journal Detail:
Title:  International journal of colorectal disease     Volume:  25     ISSN:  1432-1262     ISO Abbreviation:  Int J Colorectal Dis     Publication Date:  2010 Feb 
Date Detail:
Created Date:  2010-01-21     Completed Date:  2010-04-02     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8607899     Medline TA:  Int J Colorectal Dis     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  259-65     Citation Subset:  IM    
2nd Surgical Department, University Hospital Olomouc, Palack? University Olomouc, IPPavlova 6, 775 20 Olomouc, Czech Republic.
Export Citation:
APA/MLA Format     Download EndNote     Download BibTex
MeSH Terms
Anal Canal / physiopathology,  surgery*
Digestive System Surgical Procedures* / adverse effects
Fecal Incontinence / etiology*,  physiopathology
Hemorrhoids / complications,  physiopathology,  surgery*
Middle Aged
Muscle Contraction*
Prospective Studies
Recovery of Function
Rectum / physiopathology*
Severity of Illness Index
Time Factors
Treatment Outcome

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

Previous Document:  Rectal endosonography: just how good are we at its interpretation?
Next Document:  Novel neuropathologic findings in the Haddad syndrome.