A randomised controlled study: the effects of internal sphincterotomy of the anus on defecation disorders in patients with outlet obstructive and mixed constipation.

BACKGROUND

This study sought to investigate the effects of internal sphincterotomy of the anus in the treatment of defecation disorders in patients with outlet obstructive and mixed constipation.

METHODS

This study included 250 patients, who met the Rome III criteria for functional defecation disorder-associated constipation and were admitted to the Proctology Department in the People's Hospital of Dazu District between July 2014 and June 2016. The patients were randomly divided into the traditional medical treatment group (n=125) and the surgical treatment group (n=125), and received traditional treatment and internal anal sphincterotomy, respectively. All patient clinical data were retrospectively analyzed. Indices relating to anorectal pressure, electromyographic indices of abdominal muscles, sleep quality, anxiety and depression, defecography and anal healing before and after treatment were measured, and the effects of the different treatment modalities on defecation disorders were analyzed.

RESULTS

The total treatment effective rate was significantly higher in the surgical treatment group than in the traditional treatment group (P<0.05). The Constipation Scoring System scores at time points 1, 2 and 3 were significantly lower in the surgical treatment group than in the traditional treatment group (P<0.001). After treatment, the Hospital Anxiety and Depression Scale and Pittsburg Sleep Quality Index scores were significantly lower in the surgical treatment group than in the traditional treatment group (P<0.001). After treatment, the rectal resting pressure and 10SR were significantly lower in the surgical treatment group than in the traditional treatment group (P<0.001). After treatment, the negative conversion rate of the balloon expulsion test was significantly higher in the surgical treatment group than in the traditional treatment group (P<0.05), while the rectocele, perineum descending distance, and anorectal angle of the efforts phase were significantly lower in the surgical treatment group than in the traditional treatment group (P<0.001).

CONCLUSIONS

Internal anal sphincterotomy can significantly relieve defecation disorders and clinical symptoms, improve sleep quality, eliminate psychological disorders, and promote patient recovery.

TRIAL REGISTRATION: Chinese Clinical Trial Registry ChiCTR2100048818.