The roles of hemorrhoidectomy and lateral internal sphincterotomy in the treatment of hemorrhoids--clinical and manometric study.

To compare the clinical effect of lateral internal sphincterotomy with hemorrhoidectomy and to examine the change of anal pressure before and after these two treatments, manometric study and clinical symptoms were assessed in 56 patients with hemorrhoids. These patients were randomly allocated to one of the two treatment groups. Another twenty-seven persons with sex and age match were also studied as the normal control. There was no significant difference between the mean resting anal pressure (RAP) of the controls (72.56 +/- 11.93 mmHg) and the hemorrhoid group (75.82 +/- 8.38 mmHg). Thirty-one patients received hemorrhoidectomy and there was no significant reduction of RAP postoperatively. The mean resting anal pressure of the 25 patients receiving lateral internal sphincterotomy was reduced postoperatively (75.1 +/- 9.85 mmHg VS. 70.24 +/- 7.77 mmHg). Although lateral internal sphincterotomy did reduce the anal pressure, the clinical outcome was better in hemorrhoid group. We consider hemorrhoidectomy as the optimal choice in these two kinds of treatment. Change of anal pressure may not play such an important role in the pathogenesis of hemorrhoids.