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Role of 0.4% glyceryl trinitrate ointment after haemorrhoidectomy: results of a prospective randomised study

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Introduction

Conventional haemorrhoidectomy (CH) is well known to cause significant post-operative pain and delayed return to daily activities. Both surgical wounds and sphincterial apparatus spasms are likely responsible for the pain. In this study, we evaluated the role of glyceryl trinitrate ointment (GTN) in reducing post-operative pain, ameliorating wound healing and recovery after CH.

Patients and methods

Between 01/08 and 12/11, 203 patients with symptomatic haemorrhoids were enrolled in the study and received (103 patients) or not (100 patients) 0.4 % GTN ointment for 6 weeks after surgery. Pain was assessed using a 10-cm linear visual analogue scale (VAS). Data on post-operative pain, wound secretion and bleeding, return to normal activities and complications were recorded. Data were analysed using Fisher’s exact and Mann–Whitney tests.

Results

GTN-treated group experienced significantly less pain during the first week after surgery (p < 0.0001). This difference was more evident starting from post-operative day 4 (p < 0.0001). A significant higher percentage of untreated patients experienced severe pain (mean VAS score > 7) (10 % vs 31 %). There were significant differences in terms of secretion time (p = 0.0052) and bleeding time (p = 0.02) in favor of GTN. In addition, the duration of itching was less in the GTN group (p = 0.0145). Patients treated with GTN were able to an early return to daily activities compared to untreated (p < 0.0001). Fifteen GTN-treated patients (14.6 %) discontinued the application because of local discomfort and headache.

Conclusions

GTN ointment enhances significantly post-operative recovery, reducing pain in terms of duration and intensity. This effect might be secondary to a faster wound healing expressed by reduced secretion, bleeding and itching time.

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Authors and Affiliations

  1. Department of Surgical Sciences, University of Rome “Tor Vergata”, Rome, Italy

    Luana Franceschilli, Stefano D’Ugo, Elisabetta de Luca, Federica Cadeddu, Giovanni Milito, Nicola di Lorenzo, Achille L. Gaspari & Pierpaolo Sileri

  2. Chirurgia Generale, Policlinico Tor Vergata (PTV.6B), Viale Oxford 81, 00133, Rome, Italy

    Pierpaolo Sileri

Authors
  1. Luana Franceschilli
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  2. Stefano D’Ugo
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  3. Elisabetta de Luca
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  4. Federica Cadeddu
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  5. Giovanni Milito
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  6. Nicola di Lorenzo
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  7. Achille L. Gaspari
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  8. Pierpaolo Sileri
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Correspondence to Pierpaolo Sileri.

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Franceschilli, L., D’Ugo, S., de Luca, E. et al. Role of 0.4% glyceryl trinitrate ointment after haemorrhoidectomy: results of a prospective randomised study. Int J Colorectal Dis 28, 365–369 (2013). https://doi.org/10.1007/s00384-012-1544-1

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  • DOI: https://doi.org/10.1007/s00384-012-1544-1

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