Efficacy of Mesoglycan in Pain Control after Excisional Hemorrhoidectomy: A Pilot Comparative Prospective Multicenter Study.

INTRODUCTION: Various pain management strategies for patients undergoing open excisional hemorrhoidectomy have been proposed, yet postoperative pain remains a frequent complaint. OBJECTIVE: To determine whether mesoglycan (30 mg two vials i.m. once/day for the first 5 days postoperative, followed by 50 mg 1 oral tablet twice/day for 30 days) would reduce the edema of the mucocutaneous bridges and thus improve postoperative pain symptoms. PATIENTS AND METHODS: For this prospective observational multicenter study, 101 patients undergoing excisional diathermy hemorrhoidectomy for III-IV degree hemorrhoidal disease were enrolled at 5 colorectal referral centers. Patients were assigned to receive either mesoglycan (study group SG) or a recommended oral dose of ketorolac tromethamine of 10 mg every 4-6 hours, not exceeding 40 mg per day and not exceeding 5 postoperative days according to the indications for short-term management of moderate/severe acute postoperative pain, plus stool softeners (control group CG). RESULTS: Postoperative thrombosis (SG 1/48 versus CG 5/45) (p < 0.001) and pain after rectal examination (p < 0.001) were significantly reduced at 7-10 days after surgery in the mesoglycan-treated group, permitting a faster return to work (p < 0.001); however, in the same group, the incidence of postoperative bleeding, considered relevant when needing a readmission or an unexpected outpatient visit, was higher, possibly owing to the drug's antithrombotic properties. CONCLUSIONS: The administration of mesoglycan after an open diathermy excisional hemorrhoidectomy can reduce postoperative thrombosis and pain at 7-10 days after surgery, permitting a faster return to normal activities.

Bariatric Surgery and Rheumatic Diseases: A Literature Review.

BACKGROUND: Obesity is a debilitating growing condition and represents a challenge for every surgeon. It is associated with the activation of the inflammatory pathway and this may have a negative impact on the natural history of some rheumatic diseases. Bariatric surgery, reducing obesity, could bring to a minor activation of the well-known inflammatory pathway with improvement of these diseases. The aim of this review is to investigate the role of weight loss, achieved through bariatric surgery, in rheumatic diseases. MATERIALS AND METHODS: A systematic review of literature was undertaken to evaluate weight loss subsequent to bariatric surgery in obese patients suffering from some rheumatic diseases (Rheumatoid Arthritis, Psoriasis, Psoriatic Arthritis, Fibromyalgia, Osteoarthritis, Systemic Lupus Erythematous). Three major databases (PUBMED, EMBASE and WEB OF SCIENCE) were searched. RESULTS: Three-hundred studies were identified. After screening of titles, abstracts and inclusion criteria sixteen articles were included. Of the selected articles, seven were reviews, five were case reports, one was a clinical report, one was a retrospective study, one was a cohort study and one was an author manuscript. CONCLUSION: Weight loss, obtained through bariatric surgery, seems to reduce serum inflammatory markers as a consequence of the inflammatory pathway reduction and this is connected with both the improvement of some rheumatic diseases as well as with the reduction in the use of medicaments (steroids and immunosuppressors).

Rectal perforation during defecography: extraluminal barium impaction removed by TEM (Transanal Endoscopic Microsurgery).

AIM: Defecography is the standard diagnostic technique for the diagnosis of functional disorders of the posterior pelvic compartment. However it has some limits as radiation exposure, low-contrast resolution, some degrees of embarrassment and discomfort for the patients. Furthermore it often fails to directly visualize the changes that affect the pararectal space. Here we present a never described case of rectal perforation after defecography with barium impaction removed by TEM (Transanal Endoscopic Microsurgery). CASE REPORT: We present a case of a 50 years old woman with extraluminal barium impaction due to perforation occurred during defecography. Both pelvic MR and endoanal ultrasound confirmed the presence of the extramural rectal mass below rectal mucosa. It was completely and safely removed using transanal endoscopic microsurgery (TEM). RESULTS: The barium impaction has been radically removed using transanal endoscopic microsurgery. The post-operative period was uneventful and the patient was discharged 3 days after the operation. She is asymptomatic after 6 months from surgery. CONCLUSION: Defecography is not completely safe and its use must be indicated only in selected cases. When a patient has complications during or after this investigation he must be referred to a specialistic centre where a tailored treatment can be performed. It is mandatory that the indication for defecography and other diagnostic functional investigations is given by a colorectal specialist KEY WORD: Barium Impaction, Defecography, Rectal Perforation, TEM (Transanal Endoscopic Microsurgery).