Effect of muscle paralysis on function after conventional and stapled haemorrhoidectomy: results of a randomised controlled trial with 1 year of follow up: F23

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Aim:Sphincter dysfunction is common in patients with haemorrhoids. After haemorrhoidectomy, 50% to 90% patients experience minor or major incontinence. We aimed to determine whether muscle relaxation reduces post-operative sphincter dysfunction.Method:Patients undergoing haemorrhoidectomy were randomised to paralysed (P) and nonparalysed (NP) anaesthesia for conventional (CH) and stapled haemorrhoidectomy (PPH) forprolapsing haemorrhoids. Patients were assessed over one year by questionnaire and anorectal physiology (ARP) and endoanal ultrasound were performed before surgery and at 3 months postoperatively.Results:Thirty-seven patients [male 22; age 26-88 (median 54) years] were studied. They were distrubited as follows: NP/CH(10), NP/PPH(9), P/CH(9), P/PPH(9). Haemorrhoid grade was as follows: 2(9), 3(21) and 4(7). Baseline faecal incontinence to flatus and faeces waspresent in 67% and 31% patients. Continence and evacuation scores were similar for the P and the NP groups during the year following treatment. Maximal anal restingpressure (MRP) fell postoperatively ()15.9 ± 5.3 cm H20 (mean diff ± 2 SEM), paired t-test, P < 0.0001: PvNP, )19.3 ± 8.7 vs)13.2 ± 7.8 (trend). Max squeezepressure, rectal max tolerated volume (MTV) & compliance didn't change significantly. Endoanal USS revealed no new sphincter injuries. Patients had less pain after PPH vs CH (no difference for P vs NP). There was no significant difference in the fall of MRP CH vs PPH (18.9 ± 7.1 vs )13.1 ± 9.1).Conclusion:Sphincter hypotonia occurred post-operatively especially after CH. Conventional muscle relaxation during anaesthesia failed toprotect the internal anal sphincter.

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