Acta Medica Mediterranea, 2012, 28: 301 THE MANAGEMENT OF POSTOPERATIVE PAIN AFTER HEMORRHOIDECTOMY: ANALYSIS OF THREE METHODICS SALVATORE DE LUCA A , GIOVANNI TOMASELLO A , GIUSEPPE DAMIANO A , VINCENZO DAVIDE P ALUMBO A,B , GABRIELE SPINELLIA, MARIA CONCETTA GIOVIALE A , FILIPPO MAURIZIO ACCARDO C , STEFANIA RANDAZZO B , SILVIA FICARELLA A , A TTILIO IGNAZIO LO MONTE A a Department of Surgical and Oncological Disciplines, Palermo University, b PhD of Surgical Biotechnologies and Regenerative Medicine, Palermo University, c Department of Statistics and Maths, Faculty of Economy, Palermo University [La gestione del dolore postoperatorio conseguente ad intervento di emorroidectomia: analisi di tre metodiche] ABSTRACT Postoperative pain is one of the most common and disabling complications following hemorrhoidectomy. This study divided a total of 90 patients, undergone Milligan and Morgan hemorrhoidectomy, in three groups of 30 patient: Group A, undergone internal sphincterotomy after hemorrhoidectomy; Group B, treated with Diosmin 500 mg; Group C, treated with Paracetamol 1000 mg when required. The analysis of the median VAS score (Visual Analogic Scale) of postoperative pain, in every group pointed out a relation- ship between postoperative pain reduction and time at the three set checkpoints (1st, 3rd, 9th postoperative day) (R2= 0.9231 for Group A; R2= 0.9423 for group B; R2= 0.9423 for group C). Mean VAS scores have been worked out for the three checkpoints and we compared the results between the three groups. Conclusions: in our study, internal sphincterotomy was the only therapeutic choice able to reduce most of the others the post- operative pain, both the 1st, the 3rd and the 9th postoperative day. Received November 08, 2012; Accepted November 12, 2012 Introduction Hemorrhoids are one of the most common anorectal diseases, whose prevalence is not selec- tive for age or gender. Apparently the incidence increases with the age and it seems that about 50% of American population is affected by this patholo- gy at least in early stages. The causes of the disease are constipation, diarrhea, prolonged strain, preg- nancy, hereditary factors, prolonged upright posi- tion, increased abdominal pressure followed by venous obstruction, ageing and external sphincter anomalies. The main symptoms are bright red anal bleeding, protrusion of a mass and pain. Patients can complain for unaesthetic deformities and recur- rent thrombophlebitis episodes. Thompson (1) showed that in patients suffering hemorrhoids, the three submucosal cushions pro- lapsed together with the anal mucosa, heading to the fragmentation of the Parks’ ligament. It is possi- ble that hemorrhoids are the result of this disloca- tion and that the prolapse leads to a venous obstruc- tion, resulting in congestion, bleeding and predispo- sition to thrombosis (2) . It is known that the internal anal sphincter can have an important role in the pathogenesis: in 1977, Hancock showed how hypertonia of the internal anal sphincter was present in some patients with hemorrhoids and this condition can contribute to the genesis of the displacement of the three cush- ions (3) . A combination of the above-mentioned fac- tors seems to be important for the developing of the pathology. Milligan and Morgan’s hemorrhoidectomy (4) , that envisages the radial excision of the three hem- orrhoids, is the gold standard for the III and IV grade hemorrhoids. This methodology is assessed by complications as anal fissures, urinary retention, hemorrhage, relapse, but particularly postoperative pain (5) .