COMPARATIVE STUDY OF OPEN HEMORRHOIDECTOMY WITH OR WITHOUT LATERAL INTERNAL SPHINCTEROTOMY

Background: Hemorrhoids, affecting 4.4% to 36.4% of the population, can be classified as internal or external, with varying degrees of severity. Surgical intervention, particularly hemorrhoidectomy, is often necessary for advanced cases but is associated with significant postoperative pain. The addition of lateral internal sphincterotomy (LIS) during hemorrhoidectomy has been proposed to alleviate this pain by reducing internal anal sphincter hypertonicity. This study aims to compare postoperative outcomes, including pain relief and complications, in patients undergoing open hemorrhoidectomy with and without lateral internal sphincterotomy. Material and Methods: A comparative study was conducted at Index Medical College and Research Center over six months, involving 50 patients aged 18 to 65 years diagnosed with Grade 3 and Grade 4 hemorrhoids. Patients were randomly assigned to undergo either open hemorrhoidectomy alone (Group A) or with LIS (Group B). Postoperative pain was assessed using a numeric pain scale 24 hours post-surgery, and complications were monitored during the follow-up period. The mean age of participants was 48.75 ± 13.15 years, with a Results: higher proportion of males (60%). Patients in Group B demonstrated a significant reduction in postoperative pain at 12, 24, and 48 hours post-surgery (p=0.01). At 24 hours, 85% of those experiencing pain relief were from Group B, indicating the effectiveness of LIS in pain management. Furthermore, complications such as postoperative infection and bleeding were lower in the LIS group, while fecal incontinence was more prevalent. Lateral internal Conclusion: sphincterotomy during open hemorrhoidectomy significantly improves postoperative pain relief and reduces complications compared to hemorrhoidectomy alone. This study supports the incorporation of LIS as a beneficial adjunct in the surgical management of advanced hemorrhoids.