Chronic post-operative pain after stapled haemorrhoidectomy may depend on scar tissue in the suture line: a histo-pathological assessment: P155

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Aim:Chronic post-operative pain (CPP) following stapled haemorrhoidectomy (SH) ranges from 1.6% to 31%. CPP is cause for concern, as choice of aproper treatment depends on equally liable several conditions. Aim was to highlight the significance of histo-pathological findings in a subset of patients who showed scar tissue in the suture line.Method:Twenty-three patients who referred in a multi-institutional setting were treated for CPP from 2006 to 2008, following SH. Relation between defecation and onset of CPP or its absence was focused. Associated conditions were inflammation, aggrapphes retention, anal stenosis or scar tissue. Topical nifedipine, anaesthetic infiltrations, anal dilation, agrapphectomy and wall resection were employed. Wall resection allowed to assess specimens by immuno-histochemistry (policlonal antibody S-100, diluition 1:100/30 min.). A VAS was adopted to measure symptom relief.Results:Pain was related to defecation in 14 patients. Inflammation, stenosis and scar tissue were observed in 14, four, five patients, respectively. Recurrences following medications were 17. All specimens showed in the submucosa peripheral nerve trunk (Morton's neuroma like) and compartmentalisation of Swann cells. VAS reduced from 6.8 to 1.8.Conclusion:CPP depends on different conditions but wall resection is mandatory to healing if scar tissue causes it.

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