Abstract: Background: Various methods have been described for management of haemorrhoids. Milligan Morgan’s open haemorrhoidectomy is considered gold standard and radically performed procedure. The most dreaded sequel and main concern to open haemorrhoidectomy is post-operative pain. Our aim was to assess the advantage and risks associated in performing lateral sphincterotomy routinely with open haemorrhoidectomy with special concern in relieving post op pain.
Methods and Material: This prospective study was conducted by selection of consecutive 100 cases presenting with symptoms and signs suggestive of grade 3 and grade 4 hemorrhoids. The data in the study was collected by the use of a pretested proforma to collect relevant information from individual patient in the post-operative period. The post-operative pain was assessed using visual analog scale (VAS) and analgesic usage. Early post-operative complications like urinary retention, post-operative bleeding, incontinence and late complications like anal stenosis were assessed and tabulated for a period of 6 months.
Results: In our series, 55 patients experienced mild pain and 14 patients experienced severe pain after 24 hours. On 3rd post-operative day only 5 patients and after 1 week none of the patients complained of severe pain. Half of the patients required average of 0-2 analgesics/day but 15 patients demanded for more than 4 analgesic doses to relieve the pain. In the early post-operative period 20 patients were catheterized. 89 patients had confined bleeding and 11 patients had moderate bleeding. temporary incontinence was observed in 11 patients. During 6 months follow up none of our patients had anal stenosis.
Conclusions: Post haemorrhoidectomy pain still remains as challenging complication for surgeons following open haemorrhoidectomy because of its frequency. Lateral internal sphincter my which relieves the sphincter spasm can be tried routinely to relieve pain without significantly contributing to morbidity.
