Anorectal Manometric Changes After Standard and Stapled Hemorrhoidectomy

Abstract

In Brief Objective: Symptomatic hemorrhoids are a very common disease and are known to induce specific manometric changes that are reversed by excisional surgery. Stapled hemorrhoidopexy has recently been gaining acceptance as an alternative surgical procedure for the treatment of prolapsed, well-reducible hemorrhoids. The aim of this study was to compare the effects of standard and stapled hemorrhoidopexy on anal sphincter function. Materials and Methods: Twenty patients (10 men and 10 nulliparous women) with third-degree symptomatic hemorrhoids were recruited for the study. Patients were randomized to receive stapled hemorrhoidopexy or standard Ferguson hemorrhoidectomy. Anorectal manometry was performed before and 3 months after surgery. Manometric changes were compared in the 2 groups using Student t test; a P ≤ 0.05 was considered significant. Results: Three patients after the stapled procedure and 2 patients after conventional hemorrhoidectomy experienced transient incontinence to gas; none of the patients were incontinent 3 months after surgery. Microscopically, muscle fibers were detected in all stapled hemorrhoidopexy specimens and in 7 excisional hemorrhoidectomy specimens, but these findings did not correlate with postoperative pressure changes. There were no significant differences in preoperative basal anal pressures between the 2 groups, or between men (53 ± 10 mm Hg) and women (54 ± 9 mm Hg). Mean resting pressure significantly decreased after standard hemorrhoidectomy in both men (preoperative 54 ± 14; postoperative 40 ± 13 mm Hg; P < 0.05) and women (preoperative 56 ± 10; postoperative 40 ± 10; P < 0.05), and also after stapled hemorrhoidopexy in both men (preoperative 52 ± 8; postoperative 37 ± 8 mm Hg; P < 0.05) and women (preoperative 51 ± 8; postoperative 43 ± 10 mm Hg; P < 0.05). Vector volume also decreased after standard hemorrhoidectomy in men (preoperative 546 ± 257; postoperative 357 ± 266 mm Hg2; P < 0.05) and women (preoperative 619 ± 132; postoperative 371 ± 190 mm Hg2; P < 0.05) and after stapled hemorrhoidopexy in men (preoperative 595 ± 220; postoperative 349 ± 126 mm Hg2; P < 0.05) and women (preoperative 566 ± 174; postoperative 394 ± 133 mm Hg2; P < 0.05). No significant postoperative changes in squeeze pressure were observed after stapled hemorrhoidopexy in women (133 ± 33 vs. 140 ± 29 mm Hg) or men (259 ± 66 vs. 248 ± 71 mm Hg), nor after standard hemorrhoidectomy in men (258 ± 101 vs. 269 ± 68 mm Hg), whereas it decreased significantly in women after standard hemorrhoidectomy (174 ± 36 vs. 132 ± 24 mm Hg). Conclusions: In patients with symptomatic hemorrhoids, hypertonic basal anal sphincter pressures decrease after surgical excision of the hemorrhoid cushions and after relocation of the prolapsed piles with stapled hemorrhoidopexy. Squeeze pressures are unchanged after stapled hemorrhoidopexy but decrease in women after excisional hemorrhoidectomy. Anal pressure changes may be explained by both symptom relief after surgery and sphincter stretching during the procedure. Anal hypertonic resting pressures decrease both after hemorrhoidectomy and after stapled hemorrhoidopexy. Squeeze pressures decrease postoperatively only in women after standard hemorrhoidectomy and not after stapled hemorrhoidectomy nor in men after both procedures.