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

• Main Authors: Elnaim, Abdel Latif Khalifa, Won, Michael Pak-Kai, Ang, Chin Wee, Sagap, Ismail
• Format: Article
• Published: Springer India 2021
• Subjects: Medical technology; RD Surgery
• Online Access: http://eprints.um.edu.my/26746/
• Institution: Universiti Malaya

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.