الفهرس 
Functional Anatomy of the Anal CanalOnly 14 pages are availabe for public view
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Abstract
Anew concept of the nature of hemorrhoids has been defined in which hemorrhoids are considered as the result of downward displacement of the vascular, submucosal cushions of the anal canal. Various methods of treatment for asymptomatic patients were presented in the past. However, hemorrhoidectomy has so far been the only method for treatment of symptomatic high-grade hemorrhoids (grades III and IV).
However, the high incidence of post operative complications with this procedure reduces its effectiveness to some extent. One factor attributed to this high incidence of these complication is the high anal canal pressure which makes growing the idea of reducing the pressure to overcome this problems.
Anal canal dilatation was first described by Lord in 1969. However, due to high incidence of uncontrolled damage to the sphincteric fibers and fecal incontinence the procedure did not gain wide acceptance. Another way to reduce the anal canal pressure was internal sphincterotomy with hemorroidectomy which allows the surgeon to reduce pressure with a more graduated and reproducible fashion.
Our study was conducted to compare the anorectal function, short-term complications and patients’ well-being in two groups of patients treated with internal sphincterotomy and hemorrhoidectomy.
In 0ur study, we have compared internal sphincterotomy and hemorrhoidectomy with hemorrhoidectomy alone based on the manometric findings as well as clinical evaluation.
Manometry was performed to address the question that whether there is any correlations between internal sphincterotomy and anal canal pressure or not.
In our study, the MxRP showed a significant reduction in patients who underwent internal sphincterotomy while there were no significant changes in MSP, neither in internal sphincterotomy plus hemorrhoidectomy nor in hemorrhoidectomy alone groups. This finding could be explained by the external sphincter function which produces the MSP which was unchanged in this procedure.
The patients’ well-being after the operation was comparable in both groups which were in agreement with previous surveys and there were less post operative complication in internal sphincterotomy group (B). Some patients was developed a transient episode of fecal incontinence, mainly during the first week after the operation.
Due to this unpredictable result, internal sphincterotomy should not be performed as a routine procedure for any patient with hemorrhoids. In other words, patients with recurrence of hemorrhoids, severe Pain, prolonged constipation, or anyone with high sphincter tonicity in the digital rectal examination would be a candidate for manometric evaluation of anal canal pressure. These patients with high anal Canal pressure confirmed with manometry might receive internal sphincterotomy plus hemorrhoidectomy.