Add on Lateral Internal Sphincterotomy to Haemorrhoidectomy Reduces Post Op Pain, Improves Recovery: Study
Iraq: A recent study has revealed that the addition of lateral internal sphincterotomy to standard open haemorrhoidectomy reduces postoperative pain and early bleeding, leading to better short-term recovery. This combined approach appears to be a safe and effective improvement over conventional haemorrhoidectomy.
The findings, published in BMC Surgery, come from a prospective randomized study conducted by Alaa Hussein Alwan Alsalaumy from the College of Medicine, University of Baghdad, Iraq. The study aimed to evaluate whether combining lateral internal sphincterotomy (LIS) with open haemorrhoidectomy could improve postoperative outcomes compared to the conventional surgical approach alone.
Open haemorrhoidectomy remains a widely used and effective surgical option for advanced haemorrhoidal disease, particularly Grade III and IV cases. However, it is frequently associated with significant postoperative discomfort and early bleeding, which can delay recovery. Lateral internal sphincterotomy has been proposed as an adjunct procedure to reduce anal sphincter spasm, thereby potentially alleviating pain and promoting healing.
For this purpose, Hussein Alwan Alsalaumy conducted the study at Baghdad Teaching Hospital between March 2024 and July 2025. A total of 120 patients diagnosed with Grade III or IV haemorrhoids were randomly assigned to two equal groups. One group underwent open haemorrhoidectomy combined with LIS, while the other group received open haemorrhoidectomy alone. Randomization was performed using sealed opaque envelopes to ensure unbiased allocation.
Postoperative outcomes were assessed at multiple time points, including within the first 24 hours, at 48 hours, and at one and two weeks after surgery. Pain levels and the incidence of postoperative bleeding were the primary parameters evaluated.
The study revealed the following findings:
- The combined approach of haemorrhoidectomy with lateral internal sphincterotomy (LIS) showed clear advantages over conventional surgery.
- Patients in the combined group experienced significantly lower pain at all assessed time points.
- By one week, over 80% of patients in the combined group were pain-free, while none in the conventional group achieved this outcome.
- At two weeks, more than 94% of patients in the combined group reported no pain, compared to only a small proportion in the standard surgery group.
- The combined approach was also associated with a significant reduction in early postoperative bleeding.
- Within the first 24 hours, bleeding occurred in only a small percentage of patients in the LIS group, compared to a much higher proportion in the conventional group.
- Similar reductions in bleeding were observed at 48 hours.
- No further bleeding episodes were reported in the combined group beyond the first postoperative week.
These findings suggest that incorporating lateral internal sphincterotomy into standard haemorrhoidectomy may significantly improve early postoperative outcomes without compromising safety. The authors conclude that this combined technique offers a practical and effective modification to conventional surgery, with the potential to enhance patient recovery and comfort in the short term.
Reference:
Alsalaumy, A.H.A. Open haemorrhoidectomy combined with lateral internal sphincterotomy versus conventional haemorrhoidectomy: a prospective randomized comparative study. BMC Surg (2026). https://doi.org/10.1186/s12893-026-03714-5
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