Analysis and Measures for Anal Stricture following a Hemorrhoidectomy

Lim, Seok Won

Abstract

PURPOSE
The most common cause of anal stricture following a hemorrhoidectomy is excision of too much hemorrhoidal tissue. However, the extent of excision of the hemorrhoid and other factors that can lead to an anal stricture are not yet well known. Thus, the author analyzed cases of anal stricture in order to find a method to prevent anal stricture.
METHODS
The author analyzed 14 patients who had anal stricture following a hemorrhoidectomy among 750 hemorrhoidectomy patients at Hang clinic from Jan. 2003 through Dec. 2003. The author analyzed the relation between the incidence of anal stricture and factors such as the number of hemorrhoids removed, the depth of the ligation, and the preoperative anal tension. The author also analyzed the treatment method for postoperative anal stricture.
RESULTS
1) The male-to-female ratio for these 14 cases was 3 : 11, and the most prevalent age group was the 4th decade, followed by the 5th decade. 2) The incidences of postoperative anal stricture for patients with one to six piles removed were 0%, 0.5%, 0.9%, 4.6%, 6.5%, and 14%, respectively. 3) In analysis of anal stricture according to the depth of ligation, the patient who had two removed hemorrhoids had two high ligations without low ligation (1 case). The patients who had three removed hemorrhoids had three high ligations without low ligation (2 cases). The patients who had four removed hemorrhoids had three high ligations with one low ligaton (3 cases) and four high ligations without low ligation (3 cases). The patients who had 5 removed hemorrhoids had three high ligations with two low ligations (2 cases) and four high ligations with one low ligation (1 case). The patients who had six removed hemorrhoids had three high ligations with three low ligations (2 cases). 4) There were 5 cases (7.6%) of anal stricture for high preoperative anal tension and 9 cases (1.3%) for low preoperative anal tension. 5) The treatment methods for postoperative anal stricture were bougination (10 cases), a sphincterotomy (2 cases), and a sliding skin graft (2 cases).
CONCLUSIONS
For the prevention of postoperative anal stricture, removal of three or fewer hemorrhoids seems ideal. Low ligation may be better than high ligation in preventing anal stricture, and the hemorrhoidectomy should be performed more cautiously in cases of high preoperative anal tension. In conclusion, the number, the width, and the length of the removed hemorrhoid, as well as the preoperative anal tension, should be considered to prevent postoperative anal stricture.