A total of 1355 patients underwent internal sphincterotomy for chronic fissure in ano between 1980 and 1985. Surgical data were obtained for 1102 patients, and 829 patients responded to a questionnaire. Of the 1057 for whom the time of healing was recorded, 1033 (97.7 per cent) healed by a mean time of 5.6 weeks. No significant differences in satisfaction with the outcome or in deficits in continence were noted between groups undergoing lateral, bilateral or posterior midline sphincterotomy. Excision of the fissure was found to be unnecessary. According to responses on the questionnaires, deficits in continence ranging from 'sometimes' to 'frequently' included lack of control of flatus (35.1 per cent), soiling of underclothing (22.0 per cent) and accidental bowel movements (5.3 per cent). A significantly higher proportion of patients who had accidental bowel movements were aged over 40 years.

Sequelae of internal sphincterotomy for chronic fissure in ano.

PURPOSE: Hemorrhoidectomy is the treatment of choice for patients with third-degree or fourth-degree hemorrhoids. However, whether the closed or open technique yields better results is unknown. The purpose of this study was to compare these techniques with respect to operating time, analgesic requirement, hospital stay, morbidity rate, duration of inability to work, healing time, and follow-up results. METHODS: In this prospective and randomized study, 80 patients with third- degree or fourth-degree hemorrhoidal disease were allocated to either the open- hemorrhoidectomy (Group A, n = 40) or the closed-procedure group (Group B, n = 40). Open hemorrhoidectomy was performed according to the St. Mark’s Hospital technique, whereas the Ferguson technique was used for the closed procedure under general anesthesia with the patient in the jackknife position. RESULTS: Mean operating time was significantly shorter in Group A (35 ± 7 vs. 45 ± 8 minutes, P 0.05). Healing time was significantly shorter in Group B (2.8 ± 0.6 vs. 3.5 ± 0.5 weeks, P < 0.001). Median follow-up time was 19.5 (range, 4–40) months. The only late complication (anal stenosis) was observed in one patient in Group B. CONCLUSIONS: Although the healing time is longer, the open technique is more advantageous with respect to shorter operating time, less discomfort in the early postoperative period, and lower morbidity rate. Gencosmanoglu R, Ŝad O, Koc D, Inceoglu R. Hemorrhoidectomy: open or closed technique? A prospective, randomized clinical trial. Dis Colon Rectum 2002;45:70–75.

Hemorrhoidectomy: open or closed technique? A prospective, randomized clinical trial.

Objective
The purpose of this article is to systematically analyse the randomized, controlled trials (RCTs) comparing Ferguson or closed haemorrhoidectomy (CH) versus open haemorrhoidectomy (OH) or Milligan–Morgan haemorrhoidectomy in the management of haemorrhoidal disease (HD).

Milligan–Morgan (Open) Versus Ferguson Haemorrhoidectomy (Closed): A Systematic Review and Meta-Analysis of Published Randomized, Controlled Trials

Randomized trial of open versus closed day-case haemorrhoidectomy.

PURPOSE: Pain after hemorrhoidectomy is universal. Several attempts have been made to reduce or alleviate the pain after excisional hemorrhoidectomy. The origin of pain is undetermined. Current theories propose that the pain is mediated through the internal sphincter. This prospective, randomized study was performed to assess the degree of discomfort in patients with and without a sphincterotomy when performing a closed hemorrhoidectomy. METHODS: Between December 1999 and September 2001, 42 patients (22 males), median age 52 (range, 30–80) years, who underwent excisional hemorrhoidectomy were randomly chosen to have an internal sphincterotomy in the base of the left lateral wound. RESULTS: Thirty-nine patients were available for the study. Parameters elicited in the study were pain, postoperative bleeding, urinary retention, impairment of continence by day and by night, and day the patient returned to work. There was no statistical difference in the postoperative pain in each of the two categories at four hours after surgery, after the first bowel movement, or four days after surgery. CONCLUSIONS: Results showed no difference in the perception of pain after hemorrhoidectomy in patients who had an internal sphincterotomy compared with those who did not. Both groups were equally likely to have difficulty with control of gas and soiling.

Internal sphincterotomy with hemorrhoidectomy does not relieve pain: a prospective, randomized study.

Closed hemorrhoidectomy with local anesthesia.

Except in the presence of severe perineal suppuration or sphincter damage by previous surgery for fistulas, the rectum was preserved in all patients considered candidates for surgery for inflammatory disease of the bowel. A primary anastomosis with a single-layer 5-0 monofilament stainless steel wire was carried out when a relatively healthy rectum with erythema and granularity presented. For patients with more severe disease of the rectum, a two-stage operation with intensive interval treatment of the rectum stump with topical corticosteroids was carried out. Of a total of eighty-six patients with involvement of the colon and rectum with either Crohn's disease or chronic ulcerative colitis, fifty-six patients were treated by local abdominal colectomy and ileorectal anastomosis. Twenty-four had primary anastomosis and thiry-two had a two-stage operation. One anastomotic dehiscence developed. A mean follow-up of 8.4 years (6 months to 20 years) has been satisfactory. Only three anastomoses have been taken down for unsatisfactory results. With the proper selection of patients and with appropriate treatment of the diseased rectal segment, a large majority of patients with inflammatory disease of the bowel can have long-term salutory results after colectomy and ileorectal anastomosis.

Ileorectal anastomosis for ulcerative and Crohn's colitis.

The magnetic ring device implanted in an attempt at achieving continence in the colonic stoma, consists of a subcutaneous ring and a removable magnetic cap with a charcoal filter. Fourteen patients were selected from a potential number of 58 candidates. Fifty per cent of the patients have had good results. No complications were attributable to the implanted device. There was no incidence of parastomal hernia.

The magnetic stoma device: a continent colostomy.

Evaluation of polyglycolic acid suture vs catgut in closed hemorrhoidectomy with local anesthesia.

The Value of Colonoscopic Screening in Patients with a Family History of Colon and Rectal Neoplasia.

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