Comparative study of internal sphincterotomy against maximal anal dilatation in post operative pain after milligan morgan Haemorrhoidectomy

INTRODUCTION: Haemorrhoids are one of the most frequent anorectal disorders to affect humans. They are the most common cause of bleeding per rectum and cause considerable pain and suffering. The word haemorrhoid is derived from ancient Greek (haema = blood and rhoos =flowing). The past decade has provided new treatment for haemorrhoids such as the stapled haemorrhoidopexy (stapled anopexy), which is now resulting in large numbers of scientific publications. Other new treatment options such as haemorrhoid arterial ligation and the transanal haemorrhoidal de-arterialisation are gaining in popularity, but the scientific evidence is not yet produced. There are several hypotheses on the aetiology and there are several theories about the pathogenesis of haemorrhoids. The treatment result is often worse than usually stated in the literature with many patients complaining of persistent symptoms and disturbed continence after surgery. Surgery is considered to be the best therapeutic modality for grade 3 and 4 haemorrhoids. Treatment options for haemorrhoids include - less invasive techniques like rubber band ligation(RBL) and the more radical excisional haemorrhoidectomy (EH) which are more painful. Superiority of EH over RBL was reported for grade 3 haemorrhoids. Over the years different surgical techniques have been described to reduce post operative pain. This study was conducted to compare the post operative pain in two groups of patients treated with Lateral Internal Sphincterotomy and Maximal Anal Dilatation following a Milligan Morgan Haemorrhoidectomy. OBJECTIVES: To assess and compare the outcomes of Maximal Anal Dilatation against Internal sphincterotomy following a Milligan-Morgan Haemorrhoidectomy in terms of Post operative pain. METHODOLOGY A prospective study was done on 100 hospitalized patients at the Coimbatore Medical College Hospital during the period between June 2010 - October 2011. All patients presented with Grade 2 , 3 and 4 haemorrhoids were examined in detail to rule out other lower gastrointestinal pathologies. All patients were operated upon using the Milligan-Morgan haemorrhoidectomy. Patient selection was based on the Inclusion and Exclusion criteria as given below. Patients to be subjected to Lateral Internal sphincterotomy or Maximal Anal Dilatation were randomly selected and were divided into two groups - Group A and Group B respectively. INCLUSION CRITERIA: Recurrent bleeding, Mucous prolapse, Continuous or recurrent pruritis, Sense of heaviness, tenesmus. EXCLUSION CRITERIA: Haemorrhoidal recurrence, Anal fissure, Polypoidal lesions, Perianal fistula, Perianal abscess, Patients with bleeding tendencies, Patients refusing to participate in the study. CONCLUSION: A comparative study was undertaken to evaluate the post-operative pain after a MMH with LIS in one group versus MAD an another group. 2 groups of patients, 50 in each participated in this study. The distribution of sex was comparable in both the groups. Post-operative evaluation revealed - Significant reduction in the pain when a LIS is performed when compared to MAD. (p