Tailored therapy for different presentations of chronic pain after stapled hemorrhoidopexy
| Autor: | A. Pascariello, Guillaume Zufferey, Joan Robert-Yap, Bruno Roche, C. R. Asteria, Giuseppe Lucchini, Colpani F |
|---|---|
| Rok vydání: | 2013 |
| Předmět: |
Adult
Hemorrhoidectomy Male medicine.medical_specialty Visual analogue scale medicine.drug_class medicine.medical_treatment Chronic Pain/etiology/therapy Hemorrhoids Pain Postoperative/etiology/therapy 03 medical and health sciences 0302 clinical medicine Anal stenosis Sutures/adverse effects medicine Humans Pain Measurement Retrospective Studies Pain Postoperative medicine.diagnostic_test ddc:617 Sutures Local anesthetic business.industry Gastroenterology Chronic pain Middle Aged medicine.disease Hemorrhoids/surgery Surgery Proctoscopy Treatment Outcome 030220 oncology & carcinogenesis Stapled hemorrhoidopexy Anesthesia Anal verge Hemorrhoidectomy/adverse effects/methods Defecation 030211 gastroenterology & hepatology Female Chronic Pain business Follow-Up Studies |
| Zdroj: | Techniques in Coloproctology, Vol. 20, No 5 (2016) pp. 299-307 |
| ISSN: | 1128-045X 1123-6337 |
| Popis: | As stapled hemorrhoidopexy (SH) becomes more widely used, we see more patients with chronic postoperative anal pain after this surgery. Its presentation is variable and difficult to treat. The aim of our study was to investigate the impact of chronic anal pain after SH and whether tailored therapy was likely to achieve a favorable outcome. We retrospectively analyzed 31 consecutive patients with chronic anal pain who had undergone SH in other hospitals and were referred to our institutions. Depending on the type of pain, unrelated (at rest) or related to defecation, two groups of patients were identified. Moreover, the mean distance of the staple line from the anal verge was calculated in both groups. Treatments included: topical nifedipine, local anesthetic and steroid infiltration, removal of retained staples, anal dilation, and scar excision with mucosal suturing. A visual analog scale (VAS) was used to compare pain at baseline, postoperatively, and in the follow-up. This mean difference of the VAS score between stages was always used as the main outcome measure, depending on the type of presentation, type of pain, and type of treatment. Treatment response was defined as a 50 % decrease of VAS from baseline. There were 22 males and 9 females. The overall median age was 43 years (range 21–62 years). On digital examination and proctoscopy, 15 (48 %) patients had inflammatory changes, 19 (61 %) patients had staple retention, 8 (26 %) patients had anorectal stenosis, and 30 (97 %) patients had scar tissue. All patients had one or more of the following treatments listed from the least to most invasive: topical nifedipine in 12 (39 %) patients, anal dilation in 6 (19 %) patients, anesthetic and steroid infiltration in 18 (58 %) patients, removal of staples in 10 (32 %) patients, and scar excision in 18 (58 %) patients. The mean VAS score at baseline was 6.100, ± 1.953 SD, which dropped significantly after treatment to 1.733, ± 1.658 SD (p |
| Databáze: | OpenAIRE |
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