Postoperative pain after haemorrhoidal disease treatment: a still unsolved problem

Haemorrhoidal disease (HD) is a common proctological disorder with a major impact on quality of life. Surgical excision is the gold standard approach to manage grade III andIV HD but postoperative pain is a frequent complaint [1].Indeed, the main and most common drivers of postoperative pain after conventional excisional haemorrhoidectomy(i.e. Milligan-Morgan or Ferguson) are the incorporation ofsensitive mucosa and strands of the internal anal sphincter(IAS) in haemorrhoid pedicle ligatures and the denudingthe anal canal of its epithelium with a consequent spasm ofthe IAS, the presence of tubes and packs, the swelling of thewound, the occurrence of an anal fstula or fssure, and theinfection of the wound. In our opinion, the spasm of the IASis the main driver. In fact, excisional haemorrhoidectomycauses linear wounds that extend up to the anorectal ring inthe vascular pedicle and resemble an anal fssure with painand the presence of internal sphincter hypertonia