INFLUENCE OF SURGICAL TECHNIQUE ON PAIN AND POSTOPERATIVE STAY OF PATIENTS SUBJECTED TO AMBULATORY HEMORRHOIDECTOMY

Background and goal
Up to 40% of patients subjected to an ambulatory major surgery  present moderate-severe pain during the first 24 hours after the operation. This incidence remains around 20% in the first 48 hours, and in 10% at 7 days.
The objective of this study is to assess its influence on the postoperative stay of patients undergoing ambulatory hemorrhoidectomy, and its incidence depending on the type of surgical technique performed.

Material and Methods
We performed a prospective study  over  patients undergoing ambulatory major surgery from June 2013 to June 2016. 120 patients Undergoing hemorrhoidectomy  (58 subjected to a Hemorrhoidal Laser  Technique, HeLP, and 62 subjected to a Milligan-Morgan technique, MM) were introduced. 
All patients were subjected to a balanced general anesthesia using a laryngeal mask.

We made a comparative analysis evaluating pre, intra, and post-operative data according patients were operated under a HeLP technique or a MM technique.
To correlate different variables we used the chi square of Pearson or Fisher test for discrete variables and t-student or U Mann-Whitney test for continuous variables. Significance at  p<0.05

Results and Conclusions
4 of the patients submitted to the MM technique required admission; 3 for hemorrhage (1 of which required reintervention) and 1 for non-known atrial fibrillation . As well as 3 of those subjected to HeLP; All of them due to hemorrhage (1 of which required reintervention). There were no statistically significant differences in this regard.
Post-operative pain was the main cause of late discharge in patients undergoing ambulatory hemorrhoidectomy
Pain and analgesic requirements in the first 7 postoperative days were significantly lower when hemorrhoidectomy was performed using HeLP technique compared to MM technique

Influence of surgical technique on pain and postoperative stay of patients subjected to ambulatory hemorrhoidectomy