Efficacia della contemporanea iniezione di tossina botulinica ed applicazione perianale di trinitrato di glicerina in funzione antalgica dopo emorroidectomia sec. Milligan-Morgan


Rosalia Patti, Mariangela Angileri, Giovanni Migliore, Sergio Sammartano, Stefania Termine, Floriana Crivello, Franco Paolo Gioè, Gaetano Di Vita

Ann. Ital. Chir., 2006; 77: 503-508

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PURPOSE: After haemorrhoidectomy the maximum resting pressure (MRP) of the anal canal is significantly increased.
This increase play an important role in the making of postoperative pain. Recently, both the topical application of glyceryl
trinitrate (GT) and the intrasphincter injection of botulinum toxin (Tox), resulted effective, in reducing temporary
the MRP, although with different mechanism of action. In this study the effectiveness and safe of contemporary injection
of Tox and topical application of 300 mg/die of GT after Milligan-Morgan haemorrhoidectomy, were evaluated.
MATERIALS AND METHODS: Ten patients, undergoing Milligan-Morgan haemorrhoidectomy for 3rd and 4th degree haemorrhoids
are included in this study. In all subjects, preoperatively and after 5 and 40 day following surgery, an anorectal
manometry was performed. At the end of surgery, in all patients, 0.4 ml of solution containing 20UI of Tox was
injected and 100 mg of 0.2% of GT was applied in the anal canal and in the perianal wounds. Afterwards the patients
has been instructed to apply 100 mg of GT three times daily, for seven days. Time of perianal wounds healing, of first
defecation, to return to work, of duration of surgery, of hospital stay, the complications, postoperative pain either on
resting or during defecation, the analgesic consumption and side effects were recordered.
RESULTS: On the 5th and 40th postoperative day, the MRP resulted significantly reduced as compared to preoperative
values. Postoperative pain either on resting or during defecation was higher on the 1st assessment, afterwards it progressively
decreased. Anal incontinence was observed only in two patients, whereas headache only in one case.
CONCLUSIONS: The contemporary intrasphincter injection of Tox and perianal application of 300 mg/die of GT is safe
and effective, with an incidence of complications similar to those detected when this drugs are given alone.