Open haemorrhoidectomy combined with lateral internal sphincterotomy versus conventional haemorrhoidectomy: a prospective randomized comparative study

Open haemorrhoidectomy is an effective treatment for haemorrhoidal disease, but it is associated with significant postoperative pain and early bleeding. Lateral internal sphincterotomy (LIS) has been recommended as an adjunctive procedure to reduce sphincter spasm and facilitate post-operative healing. This study was designed to compare postoperative pain and bleeding in patients treated with an open haemorrhoidectomy with or without a lateral internal sphincterotomy. This prospective, randomized, comparative study was conducted at Baghdad Teaching Hospital from March 2024 to July 2025. A total of 120 patients with Grade III or IV haemorrhoids were randomly divided into two groups: the group of open haemorrhoidectomy with lateral internal sphincterotomy (Group A, n = 60) or the group of open haemorrhoidectomy alone (Group B, n = 60). Allocation was made by means of sealed, opaque envelopes. Pain and postoperative bleeding were compared during the first 24 h, 48 h, one week and two weeks thereafter. Statistical analysis was carried out using the chi-square test or Fisher’s exact test, with p < 0.05 considered statistically significant. Postoperatively, patients who underwent haemorrhoidectomy and lateral internal sphincterotomy had significantly less pain during all assessed time points. At 1 week, 81.6% of patients in Group A were pain-free compared to none in Group B (risk difference 81.7%, 95% CI 71.9%–91.5%; p < 0.001). At 2 weeks, 94.2% in Group A were pain-free vs. 3.5% in Group B (risk difference 90.7%, 95% CI 82.8%–98.7%; p < 0.001). Bleeding occurred in 5% of patients in Group A compared to 41.6% in Group B at 24 h (p < 0.001), and in 5% versus 35% at 48 h (p < 0.001). No further bleeding episodes were observed in Group A beyond the first postoperative week. Inclusion of lateral internal sphincterotomy in the standard open haemorrhoidectomy decreases both postoperative pain and early bleeding, which leads to improved short-term recovery. This combination method seems to be a safe and efficacious modification of conventional haemorrhoidectomy. This study was retrospectively registered at ClinicalTrials.gov on 13th January 2026. Identifier NCT07360912.