Internal anal sphincterotomy plus free dilatation versus anal stretch with special criticism of the anal stretch procedure for hemorrhoids

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Abstract
The object of this paper has been to present an enlightened, much simplified approach to treatment of the hemorrhoid syndrome. The orthodox treatment, especially the teaching, has remained too rigid and stereotyped. The proctologist must strive to develop greater skill in all available techniques, so that he can truly say that no two operations are alike. There is no panacea such as many surgeons imagine that the old stretch operation can now confer on the hemorrhoid problem. Hemorrhoid surgery, as also that of anal fissure, anorectal abscess and fistula, minor plastic operations for anal stenosis, and other associated procedures should be dealt with by experts, usually able to perform such operations using local anesthesia, on a completely ambulant basis. In a purely proctologic practice only about 20 per cent of all hemorrhoid cases require definitive surgery, as most respond satisfactorily to conservative measures. This paper has given much space to discussing the problem of spasm of the anorectal sphincteric mechanism. It is hoped that the surgical conclusions arrived at will help to dispel the mistaken approach of using the old, crude procedure of anal stretch or manual dilatation of the anus to overcome the comparatively simple problem of “the over-tight back passage.” It is felt that anal stretch has only one true indication, that of its rapid performance at the termination of a low colonic or rectal anastomosis to achieve intraluminar atmospheric pressure at the suture line. The place of cryosurgery in the treatment of hemorrhoids still awaits authoritative analysis.