Functional and structural abnormalities after milligan hemorrhoidectomy: a comparison with healthy subjects.

Abstract

Fecal incontinence is a rare but well-known adverse effect of hemorrhoidectomy. The objective of this study was to identify possible reasons for incontinence after hemorrhoidectomy. We conducted a retrospective comparative study. The study was performed in 1 university hospital and 1 general district hospital serving 2 counties in central Sweden. In a cohort of 418 patients with consecutive Milligan hemorrhoidectomies, 40 reported fecal incontinence that was attributed to surgery. Of these, 19 patients agreed to participate. Fifteen age- and sex-matched patients from the same cohort who were operated on, but without symptoms of incontinence, were also studied, as was a third reference group of 19 age- and sex-matched persons serving as a population-based control group. All of the participants answered a bowel function questionnaire and underwent clinical evaluation, including rectoscopy, anal manometry, saline infusion test, and endoanal ultrasound. We evaluated anal resting and squeeze pressures, sphincter defects, and continence function. The symptomatic patients had higher incontinence scores than the control groups (p = 0.00002). The mean resting pressure at the high-pressure zone was also reduced in this group (p = 0.047). External sphincter injuries were detected in 4 (20%) of 19 subjects compared with none in the control group (p = 0.11). Saline infusion test in the patients reporting incontinence showed reduced ability to hold liquids compared with healthy controls (p = 0.004). This study was limited by selection bias and limited numbers in the groups. In the group of patients reporting incontinence after hemorrhoidectomy, there was a proportion with sphincter defects and impaired sphincter function. These results indicate a need for cautious patient selection and improved or alternative surgical techniques.