Hemorrhoidectomy and sphincterotomy. A prospective study comparing the effectiveness of anal stretch and sphincterotomy in reducing pain after hemorrhoidectomy.

The effectiveness of two maneuvers, anal stretch (group 1) and sphincterotomy (group 2), were evaluated in reducing posthemorrhoidectomy pain. The study included 133 patients in group 1 and 125 patients in group 2. Immediate follow-up results showed that 18.4 percent of patients in group 2 required narcotic analgesics in the first 24 hours as compared with 100 percent of group 1 patients (P less than .01). Urinary retention developed in 4 percent of the patients in group 2 and 39 percent of the patients in group 1 (P less than .01). Pain associated with the first postoperative motion was severe in 96.2 percent of those in group 1 as compared with 6.4 percent of patients from group 2 (P less than .01). Moreover, long-term follow-up showed that 57.3 percent of group 1 patients continued to suffer from fecal soiling for ten weeks as compared with 6.4 percent in group 2 who suffered only 4.5 weeks (P less than .01). The routine performance of sphincterotomy through one of the hemorrhoidectomy wounds significantly reduced posthemorrhoidectomy pain and complications.