Lord'sprocedure: A critical study of its basic principle

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Abstract
In 5 patients affected by second-degree haemorrhoids a biopsy of one of the bands mentioned by Lord was taken and studied by light microscopy using Masson'stechnique. The study proved the structures to be normal smooth and striated muscle fibres. Anal pressure was studied preoperatively in 20 patients with haemorrhoids and postoperatively in 25 patients, 14 after a Lord'sprocedure and 11 after a conventional Milligan and Morgan procedure. A statistical study of the pressure values obtained in the three groups at centimetre intervals showed no significant differences between the three groups except when we compared the values obtained at 1 cm of the anal verge in untreated patients and in those operated on by the Milligan and Morgan procedure. Sixty patients affected by second- or third-degree haemorrhoids without other anal complaints were randomly allocated to one of two groups. Thirty were operated on by Lord'smethod and the other 30 by the Milligan and Morgan procedure. Fifty-two of the 60 patients were followed up for 1 year or longer post-operatively. Twenty-eight had been operated on by Lord'smethod and the other 24 by the Milligan and Morgan technique. Clinical results were statistically assessed within and between techniques. The study showed that with both methods bleeding, prolapse and pain disappeared but that pruritus was not modified by the operations. On the other hand, the results suggest that Lord'smethod produces flatus incontinence. The results of the statistical comparison between techniques showed that there is no signficant difference between the two methods in respect of prolapse, pain and pruritus. On the other hand, the results obtained for prolapse and incontinence with the Milligan and Morgan technique were significantly better than with Lord'smethod. Our results suggest that stretching of the anal sphincters does not have the physiopathological basis suggested by Lord. From a clinical point of view, the limited number of controlled patients in our series on 1-year follow-up only does not allow final conclusions to be drawn.