ORIGINAL ARTICLE Long-term manometric study of anal sphincter function after hemorrhoidectomy Rosalia Patti & Piero Luigi Almasio & Matteo Arcara & Massimiliano Sparacello & Stefania Termine & Sebastiano Bonventre & Gaetano Di Vita Accepted: 1 June 2006 / Published online: 22 July 2006 # Springer-Verlag 2006 Abstract Background and aim Data on maximum resting pressure (MRP) and maximum squeeze pressure (MSP) changes after hemorrhoidectomy are not univocal and follow-up of patients undergoing surgery is mostly short-lived. The aim of this study was to prospectively examine during 1-year follow-up the long-term manometric results of MRP, MSP, and ultra slow wave activity (USWA) within a set of patients undergoing Milligan–Morgan hemorrhoidectomy as compared to healthy controls. Materials and methods Twenty patients with hemorrhoids of third and fourth degree were enrolled and anorectal manometry was performed preoperatively, on the 5th day, and after 1, 6, and 12 months after surgery. Results On the 5th and 30th day after hemorrhoidectomy, USWA was slightly increased as compared to preoperative status. Six and 12 months after surgery, patients with USWA were significantly less in comparison to preopera- tive assessment without differences with healthy subjects. After surgery, MSP values were not significantly different to baseline values. On the 5th postoperative day after hemorrhoidectomy, MRP was significantly greater than baseline preoperative values. Thirty days after surgery, MRP values were similar to those detected preoperatively, but still significantly increased as compared to healthy subjects. After 6 and 12 months, MRP values were significantly lower than those detected during preoperative phase and comparable to healthy subjects. Conclusions Our data support that Milligan–Morgan hem- orrhoidectomy induces a complete resolution of typical manometric alterations of disease and that the excision of anal cushions is responsible only for mild and transient alteration of anal continence. Keywords Hemorrhoidectomy . Maximum resting pressure . Ultra slow waves activity Introduction Hemorrhoids are normal structures constituted by connec- tive tissue cushions surrounding direct arterovenous com- munications between terminal branches of rectal arteries and veins [1]. The term of hemorrhoids usually identifies signs and symptoms following distal displacement of anal cushions caused by fragmentation and degenerative changes in the submucosal tissue of the anal canal. The cushions serve as a conformable plug to ensure complete closure of the anal canal and contribute approximately to the 15–20% of maximum resting pressure (MRP) [2]. Several studies have shown an elevation of MRP and increased ultra slow waves activity (USWA) in patients with hemorrhoids when compared with controls [3]. On the contrary, data regarding maximum squeeze pressure (MSP) are conflicting [3]. Moreover, it is not clear whether elevated resting pressure is caused by or due to enlarged hemorrhoids [4]. Int J Colorectal Dis (2007) 22:253–257 DOI 10.1007/s00384-006-0174-x R. Patti : M. Arcara : M. Sparacello : S. Termine : S. Bonventre Department of Surgical and Oncological Science, Division of General Surgery, University of Palermo, Palermo, Italy P. L. Almasio Department of Gastroenterology, University of Palermo, Palermo, Italy G. Di Vita (*) Division of General Surgery, University of Palermo, Via Autonomia Siciliana 70, 90143 Palermo, Italy e-mail: divitagaetano@libero.it