Effect of lateral internal sphincterotomy in patients undergoing excisional hemorrhoidectomy

Medicine (Baltimore). 2018 Aug;97(32):e11820. doi: 10.1097/MD.0000000000011820.


Background: Excisional hemorrhoidectomy (EH) is the major surgical option for high-grade symptomatic hemorrhoids, but it has some shortcomings, especially postoperative pain. This study was performed to assess the effect of lateral internal sphincterotomy (LIS) in patients undergoing excisional hemorrhoidectomy.

Methods: A systematic literature search (Medline, Embase, Cochrane Library, Science Citation Index, Science Direct, Springer Link, Ovid Journals, and EBSCO) was performed to identify all eligible articles. Randomized controlled trials (RCTs) published until July 7, 2017 comparing EH combined with LIS (experimental group) with EH only (control group) were eligible for inclusion. The primary outcome of interest was postoperative pain.

Results: Ten RCTs involving 1560 patients were identified for inclusion. The pooled analysis revealed that patients undergoing EH and LIS were associated with lower pain score [standardized mean difference (SMD), -0.75; 95% confidence interval (CI), -1.14 to -0.36; z = 3.76; P = .0002] and resting anal pressure [odds ratio (OR), -17.19; 95% CI, -25.66 to -8.72; z = 3.98; P < .0001], and lower incidence of anal stricture (OR, 0.12; 95% CI, 0.03-0.53; z = 2.85; P = .004). However, the differences of urinary retention, bleeding and length of hospital stay were similar between the 2 methods.

Conclusion: Our meta-analysis suggests that LIS effectively relieves postoperative pain and reduces patient's postoperative analgesic requirements. LIS also reduces the incidence of anal stenosis but increases the incidence of fecal incontinence.

Publication types

  • Meta-Analysis
  • Review

MeSH terms

  • Anal Canal / pathology
  • Hemorrhoidectomy / adverse effects
  • Hemorrhoidectomy / methods*
  • Hemorrhoids / surgery*
  • Humans
  • Lateral Internal Sphincterotomy / adverse effects
  • Lateral Internal Sphincterotomy / methods*
  • Length of Stay
  • Pain, Postoperative / epidemiology
  • Postoperative Complications / epidemiology*
  • Postoperative Hemorrhage
  • Randomized Controlled Trials as Topic