Doppler-guided hemorrhoidal artery ligation with hemorrhoidopexy: source and prevention of postoperative pain

Transanal hemorrhoidal dearterialization, although it showed reliability, has not completely removed the issue of postoperative pain. We investigated the causes of postoperative pain and proposed some changes of the technique in order to eliminate it. One hundred six out of 188 operated patients were considered. Postoperative pain was investigated using a Visual Analogue Score dividing patients into three groups: 0 to 3, 4 to 6, and 7 to 10. On the basis of these results, we proposed some variations of the technique. A second group of 25 patients was therefore treated with the modified technique. Statistical analysis was conducted using the Fisher's exact test, two-tailed. Pain intensity, surgical approach, and changes in the technique were analyzed, and a new proposal for a modified technique has been developed. The group of 106 patients, 64 males and 42 females, were divided: 71 III grade and 35 IV grade. Pain was detected in 37 cases (35 %).Fifteen males (23.50 %) were divided as follows: 8 mild and 7 medium or intense. Twenty-two females (52.38 %) were divided as follows: 11 mild and 11 with medium or intense. For what concerns the variable grade, the pain was present in 15 III G and 22 IV G with statistic significant difference (p value 0.00333). Among the 18 patients (7 males and 11 females) who had severe pain, they all had a number of mucopexies > 4, while among 19 patients (8 males and 11 females) with mild pain, only 5 had a number of mucopexies > 4, resulting in a statistic significant difference (p value 0.031). In the second group, pain was drastically reduced. We believe it is necessary to extend the sample in order to definitively adopt the proposed amendments. The review of the causes of postoperative pain and the changes adopted compared with those proposed in literature have allowed us to greatly reduce postoperative pain.