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Role of 0.4 % glyceryl trinitrate ointment after stapled trans-anal rectal resection for obstructed defecation syndrome: a prospective, randomized trial

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Purpose

The anal fissure and spasm represent possible complications and causes of postoperative anal pain in patients that have undergone stapled trans-anal rectal resection (STARR). The etiology of these complications is still questioned such as the treatment modality. This study was designed to evaluate the effectiveness of topical glyceryl trinitrate (GTN) 0.4 % in determining decrease of incidence of postoperative anal spams and fissure and reduction of early postoperative pain.

Methods

From a total of 243 patients referred for obstructed defecation syndrome (ODS) 104 (42.7 %) underwent STARR and were randomized to receive (Group 1) or not (Group 2) topical 0.4 % GTN ointment every 12 h for four postoperative weeks. Postoperative evaluation was made at 1, 6, and 12 months.

Results

At 1 month follow-up, the incidence of anal spasm in Groups 1 and 2 was, respectively, 0 and 14.6 % (6/41) (p = 0.010; Fisher's exact test). The incidence of anal fissure was 4/41 (9.7 %) in Group 2 and 0/44 (0 %) in Group 1 (p = 0.05; Fisher's exact test). Significant differences in median visual analogue scale score between groups were found at 1 week and 1 month follow-up (1; 0–5 vs. 2; 0–7: p = 0.0104; Mann–Whitney U test).

Conclusion

Anal spasm and fissure may represent a cause of early postoperative anal pain in patients that have undergone STARR procedure for ODS. The use of topical GTN 0.4 % ointment in the early postoperative course seems to reduce the incidence of anal spasm and fissure and to improve the associated early postoperative pain.

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Authors and Affiliations

  1. Mediterranea Hospital, Naples, Italy

    Domenico Izzo, Paolo Falco & Roberto Rea

  2. Surgical Dept, Second University of Naples, Piazza Miraglia 2, 80138, Naples, Italy

    Antonio Brillantino

  3. Radiological Dept, Second University of Naples, Piazza Miraglia 2, 80138, Naples, Italy

    Francesca Iacobellis

  4. Villa delle Querce Hospital, Naples, Italy

    Adolfo Renzi

Authors
  1. Domenico Izzo
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  2. Antonio Brillantino
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  3. Francesca Iacobellis
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  4. Paolo Falco
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  5. Adolfo Renzi
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  6. Roberto Rea
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Corresponding author

Correspondence to Antonio Brillantino.

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Izzo, D., Brillantino, A., Iacobellis, F. et al. Role of 0.4 % glyceryl trinitrate ointment after stapled trans-anal rectal resection for obstructed defecation syndrome: a prospective, randomized trial. Int J Colorectal Dis 29, 105–110 (2014). https://doi.org/10.1007/s00384-013-1758-x

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  • DOI: https://doi.org/10.1007/s00384-013-1758-x

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