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Query: UMLS:C0030201 (Postoperative pain)
 1,085 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The ideal therapy for early stages of hemorrhoids is always debated. Some are more effective but are more painful, others are less painful but their efficacy is also lower. Thus, comfort or efficacy is a major concern. In the present randomized study, a comparison is made between infrared coagulation and rubber band ligation in terms of effectiveness and discomfort. One hundred patients with second degree bleeding piles were randomized prospectively to either rubber band ligation (N = 54) or infrared coagulation (N = 46). Parameters measured included postoperative discomfort and pain, time to return to work, relief in incidence of bleeding, and recurrence rate. The mean age was 38 years (range 19-68 years). The mean duration of disease was 17.5 months (range 12 to 34 months). The number of male patients was double that of females. Postoperative pain during the first week was more intense in the band ligation group (2-5 vs 0-3 on a visual analogue scale). Post-defecation pain was more intense with band ligation and so was rectal tenesmus (P = 0.0059). The patients in the infrared coagulation group resumed their duties earlier (2 vs 4 days, P = 0.03), but also had a higher recurrence or failure rate (P = 0.03). Thus, we conclude that band ligation, although more effective in controlling symptoms and obliterating hemorrhoids, is associated with more pain and discomfort to the patient. As infrared coagulation can be conveniently repeated in case of recurrence, it could be considered to be a suitable alternative office procedure for the treatment of early stage hemorrhoids.
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PMID:Infrared coagulation versus rubber band ligation in early stage hemorrhoids. 1450 78

The technique of haemorrhoidectomy with the transfixed stitch technique (TST) is a surgical treatment modality for haemorrhoids that is available to the surgeon. The authors, through a personal interpretation of haemorrhoids based on the PATE 2006 classification, report the results of a comparative trial, using TST with two different surgical threads, Assufil and Monofil. The aim of this prospective randomised trial was to compare the results with the use of each surgical thread, analysing early postoperative side effects (bleeding, urinary retention, pain), late postoperative side effects (pain, bleeding, stricture, anal secretion, tenesmus and faecal incontinence), return to active life and quality of life. Patients with grade III-IV haemorrhoids were enrolled in our study and divided into two groups, one treated with TST using Assufil and the other treated with TST using Monofil. The main outcome measures such as analgesic intake during the first week, early and late side effects, return to active life and quality of life were evaluated. Patients were followed for six months after surgery. A total of 40 patients were enrolled, 20 per group. The pain score after surgery was significantly lower in all patients treated with TST. Thirty percent of TST patients treated with Monofil took analgesics in comparison to 35% of the Assufil group (p = ns). Postoperative pain after the start of bowel movements in TST patients was similar in the two groups. TST patients treated with Monofil showed a low incidence of discomfort and surgical oedema in comparison to the Assufil group. Side effects, surgical time and return to active life in patients treated with TST were similar in the two groups. TST haemorrhoidectomy is more advantageous utilising Monofil surgical thread because of its lower complication rate.
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PMID:[Should surgical thread influence the outcome of haemorrhoidectomy with the transfixed stitch technique?]. 1868 81

Most patients with hemorrhoidal disease may be treated conservatively Along the years several surgical options have been proposed. including closed open and semiclosed hemorrhoidectomy (HC), radiofrequency HC (LigaSure), piles' suture or Farag operation, manual and stapled haemorrhoidopexy (PPH) with or without excision of anal tags, doppler hemorrhoidal artery ligation with or without recto-anal mucopexy ano-mucosal flap circumferential HC or Whitehead-Rand procedure. Randomized prospective trials and metanalyses have been carried out with the aim of finding the gold standard operation. When carried out for advanced disease, HC appears to be more effective than PPH, which achieves good results in third degree, but carries high reintervention rate in fourth degree piles. Almost all trials comparing open and closed HC show similar outcomes. None of the costly innovations appears to be superior when compared with conventional procedures in terms of cure of the disease in the long term. PPH carries less postoperative pain and a shorter convalescence than HC On the other hand, while carrying a higher rate of complications, it may be responsible of the so-called "PPH syndrome", consisting of proctalgia, tenesmus and urgency Occasional recto-vaginal fistulas have been described after PPH, if not even of rectal perforation and other life-threatening complications. Postoperative pain is very rare after Doppler hemorrhoidal arteries ligation and may be reduced following HC using nitrate ointments and botulin toxin injection, aimed at releasing anal spasm after surgery, more safely than by an internal sphincterotomy LigaSure HC decreases the risk of severe postoperative bleeding, which may be effectively treated by rectal balloon tamponade. Permanent and gross anal incontinence are unlikely to follow both HC and PPH Most cases of anal stricture following HC may be treated by anal dilation. Societies' guidelines recommend a tailored surgery, i.e., the use of different procedures according to the grade of haemorrhoids, which suggests that patients should be operated by a specialist colorectal surgeon, able to perform different surgeries and to deal with complications and failures.
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PMID:Surgical management of hemorrhoids. State of the art. 2168 10