Postoperative pain after haemorrhoidal disease treatment: a still unsolved problem
Gaetano Gallo, Marta Goglia, Mario Trompetto
Abstract
Haemorrhoidal disease (HD) is a common proctological disorder with a major impact on quality of life. Surgical excision is the gold standard approach to manage grade III and IV HD but postoperative pain is a frequent complaint [1]. Indeed, the main and most common drivers of postoperative pain after conventional excisional haemorrhoidectomy (i.e. Milligan-Morgan or Ferguson) are the incorporation of sensitive mucosa and strands of the internal anal sphincter (IAS) in haemorrhoid pedicle ligatures and the denuding the anal canal of its epithelium with a consequent spasm of the IAS, the presence of tubes and packs, the swelling of the wound, the occurrence of an anal fstula or fssure, and the infection of the wound. In our opinion, the spasm of the IAS is the main driver. In fact, excisional haemorrhoidectomy causes linear wounds that extend up to the anorectal ring in the vascular pedicle and resemble an anal fssure with pain and the presence of internal sphincter hypertonia