The effect of internal sphincterotomy versus botulinum toxin injection in the control of post hemorrhoidectomy pain; a randomized controlled trial.

Background: For the majority of patients, post-hemorrhoidectomy pain remains a significant issue. The purpose of this study is to examine how well botulinum toxin injection and lateral internal anal sphincterotomy (LIS) improve wound healing and post- hemorrhoidectomy discomfort.Methods: A prospective randomized controlled study including 60 individuals with grade III and IV hemorrhoids was carried out. The patients were randomly assigned to one of three groups: the control group, the botulinum toxin injection group, or the lateral internal sphincterotomy group. The visual analogue scale for pain was used to evaluate the patients, and they were monitored until the wound was fully healed. Time to resume daily activities and postoperative problems were noted.Results: This research involved sixty participants. There were 20 patients in each group. At one week, the control group's mean pain score was 5.9±2.8, the botox group’s was 5.8±2.8, and the LIS group's was 5.1±2.2 (P=0.043). In contrast, the second-week values were 3.9±1.7 for the control group, 3.9±2.9 for the botox group, and 1.9±1.9 for the LIS group (P=0.002). There was no discernible difference between the groups in the amount of time spent using analgesics overall, the amount of time required to defecate painlessly, the amount of time needed for wound healing, and the amount of time needed to resume regular activities.Conclusion: LIS is superior to botulinum toxin in improving the post-hemorrhoidectomy pain at 1 and 2 weeks of follow up. However, both techniques have no role in wound healing or in early return to activities.