When to combine internal sphincterotomy with hemorrhoidectomy

: 396 patients, treated with hemorrhoidectomy (278 Parks, 118 Milligan-Morgan) were submitted to preoperative manometry, which, in 158 patients (39.9%), revealed high anal resting pressure (TBS), with or without an associated anal fissure; this group was submitted to a regulated lateral sphincterotomy (SILR) in association with the haemorroidectomy. The manometric follow-up, two mounts after the operations showed similar TBS values in both groups of patients. The authors conclude that normal values of TBS after Hemorroidectomy can be reached only by associating sphincterotomy in manometrically selected cases.