A Comparative Study of Efficacy of Sphincterotomy in Open Haemorrhoidectomy

Abstract

Background: Open Milligan–Morgan haemorrhoidectomy remains an effective operation for advanced haemorrhoidal disease, although postoperative pain, urinary retention, bleeding and delayed recovery continue to affect patient comfort and resource use. Internal sphincter spasm is considered an important contributor to pain after excisional haemorrhoidectomy. Lateral internal sphincterotomy may reduce resting sphincter pressure and improve early recovery, but its clinical value must be assessed against procedure-related morbidity.

Aim: To compare early postoperative outcomes following open haemorrhoidectomy with and without lateral internal sphincterotomy in patients with grade III or IV haemorrhoids.

Methods: This observational comparative clinical study was conducted in the Department of General Surgery at a tertiary-care centre in Visakhapatnam from May 2024 to April 2025. Sixty consenting adults with clinically and proctoscopically diagnosed grade III or IV haemorrhoids were analysed in two equal groups: Group A underwent open Milligan–Morgan haemorrhoidectomy, whereas Group B underwent open haemorrhoidectomy with lateral internal sphincterotomy. Postoperative pain was measured using a 0–10 visual analogue scale on days 1, 3 and 7. Urinary retention, postoperative bleeding, duration of hospitalization and wound-healing time were recorded. Continuous variables were compared using an independent t-test or Mann–Whitney U test, and categorical variables using the chi-square test; p<0.05 was considered statistically significant.

Results: Baseline age, sex and haemorrhoidal-grade distributions were descriptively similar between groups: mean age was 45.3 ± 7.6 years in Group A and 44.9 ± 8.1 years in Group B, and each group included 21 patients with grade III and nine with grade IV disease. Mean VAS scores were lower in Group B on day 1 (3.5 vs 6.6), day 3 (2.5 vs 5.0) and day 7 (1.5 vs 3.5), with p<0.001 for every comparison. Mean hospital stay was 3.0 versus 4.0 days, and mean wound-healing time was 14.0 versus 18.0 days, respectively (both p<0.001). Urinary retention occurred in 2/30 patients in Group B and 8/30 in Group A (Pearson χ² p=0.038). Any postoperative bleeding occurred in 4/30 and 9/30 patients, respectively; this difference was not statistically significant on two-sided Fisher’s exact testing (p=0.209).

Conclusion: Open haemorrhoidectomy with lateral internal sphincterotomy was associated with lower postoperative pain, less urinary retention, shorter hospitalization and faster wound healing. Postoperative bleeding did not differ significantly between the groups.