Surgical approach to piles at risk of severe postoperative pain: tricks and tips


COD: 2714_24_07_2017_AOP Categorie: , ,

Domenico Tuscano, Linda D’Amore, Fabio Gaj, Paolo Bruzzone, Elena Annesi,
Daniele Ceccarelli, Paolo Negro, Maria Romana Grimaldi, Francesco Gossetti

Ann Ital Chir, Digital Edition 2017, 6
Epub Ahead of Print – July 24

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AIM: Aim of the present study is to propose a clinic-therapeutic course for the treatment of hemorrhoidal disease able to
combine radical anatomic surgery with a painless postoperative path.
MATERIAL OF STUDY: The present study is based on the evaluation of 20 selected patients who underwent radical hemorrhoidectomy
for very high grade hemorrhoidal disease. The clinical course was characterized by careful bowel cleansing,
hemorrhoidectomy according to Milligan-Morgan using LigaSure, intraoperative perianal infiltration of Ropivacaine
and postoperative use of analgesic drugs.
DISCUSSION: A low postoperative pain may descend from a scheduled timing of clinical procedures. Preoperative bowel
cleansing delays the first postoperative evacuation, thus avoiding the perianal nerve stimulation. The use of LigaSure
allows to perform surgical excision in a perfect way: lack of hemostatic stitches, less tissue trauma, very low early morbidity.
A rational and scheduled intra and postoperative drug administration offers a highly significant contribution to
the pain control. The intra and postoperative use of drugs makes it possible to perform the so-called “preventive anesthesia
with activation of the pain memory” and postoperative evacuations with low pain perception. All patients, in fact,
reported low and well tolerated pain, satisfaction and return to normal activities in a short period.
CONCLUSIONS: Radical hemorrhoidectomy with LigaSure and attention to pre, intra and postoperative protocol makes the
procedure painless, safe and with low morbidity.