A literature review on the role of chemical sphincterotomy after Milligan-Morgan hemorrhoidectomy.

Abstract

OBJECTIVE:

A literature review of agents used to induce chemical sphincterotomy after hemorrhoidectomy.

METHODS:

Electronic databases were searched from January 1935 to August 2010.

RESULTS:

Two randomized controlled trials compared calcium channel blockers (Ca2) with placebo. Pain appeared to be less for up to 7 days, and its side-effect profile was comparable to the control group. Four randomized controlled trials examined the role of glyceryl trinitrate (GTN). GTN may be used up to 6 weeks to aid healing. Pain may be slightly less during its use and potentially offers less pain during defecation in the first 48 h. Its side-effect profile including headache appears comparable to placebo. Three randomized controlled trials investigated botulinum toxin A (BTX). BTX may be used to aid healing after hemorrhoidectomy. Pain may be less for up to a week after surgery. Its side-effect profile including incontinence to flatus appears comparable to placebo. It would be especially useful in cases where poor patient compliance is envisaged. Only one paper was found comparing BTX with GTN. BTX may be preferred over GTN due to better pain control and fewer side effects.

CONCLUSION:

BTX, Ca2, and GTN may give effective pain relief for a week after hemorrhoidectomy. Their side-effect profiles are comparable to placebo.

• Authors: Muhammad Rafay Sameem Siddiqui, Chuk Abraham-Igwe, Arun Shangumanandan, Veronica Grassi, Ian Swift, Al Mutaz Abulafi
• Journal: International journal of colorectal disease (Int J Colorectal Dis) Vol. 26 Issue 6 Pg. 685-92 (Jun 2011) ISSN: 1432-1262 [Electronic] Germany
• PMID: 21212965 (Publication Type: Journal Article, Meta-Analysis, Review)

Chemical References

• Calcium Channel Blockers
• Botulinum Toxins
• Nitroglycerin

Topics

• Anal Canal (drug effects, surgery)
• Analgesia
• Botulinum Toxins (pharmacology, therapeutic use)
• Calcium Channel Blockers (pharmacology, therapeutic use)
• Digestive System Surgical Procedures (adverse effects, methods)
• Health Planning Guidelines
• Hemorrhoids (drug therapy, surgery)
• Humans
• Nitroglycerin (pharmacology, therapeutic use)
• Pain Measurement
• Postoperative Complications (etiology)
• Randomized Controlled Trials as Topic
• Wound Healing (drug effects)