Annals of Coloproctology

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Original Articles

ERAS

Clinical impact of a multimodal pain management protocol for loop ileostomy reversal: Jeong Sub Kim, Chul Seung Lee, Jung Hoon Bae, Seung Rim Han, Do Sang Lee, In Kyu Lee, Yoon Suk Lee, In Kyeong Kim; Ann Coloproctol. 2024;40(3):210-216. Published online June 19, 2024; DOI: https://doi.org/10.3393/ac.2022.01137.0162

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Purpose
As introduced, multimodal pain management bundle for ileostomy reversal may be considered to reduce postoperative pain and hospital stay. The aim of this study was to evaluate clinical efficacy of perioperative multimodal pain bundle for ileostomy.
Methods
Medical records of patients who underwent ileostomy reversal after rectal cancer surgery from April 2017 to March 2020 were analyzed. Sixty-seven patients received multimodal pain bundle protocol with ileostomy reversal (group A) and 41 patients underwent closure of ileostomy with conventional pain management (group B).
Results
Baseline characteristics, including age, sex, body mass index, American Society of Anesthesiologists classification, diabetes mellitus, and smoking history, were not significantly different between the groups. The pain score on postoperative day 1 was significant lower in group A (visual analog scale, 2.6 ± 1.3 vs. 3.2 ± 1.2; P = 0.013). Overall consumption of opioid in group A was significant less than group B (9.7 ± 9.5 vs. 21.2 ± 8.8, P < 0.001). Hospital stay was significantly shorter in group A (2.3 ± 1.5 days vs. 4.1 ± 1.5 days, P < 0.001). There were no significant differences between the groups in postoperative complication rate.
Conclusion
Multimodal pain protocol for ileostomy reversal could reduce postoperative pain, usage of opioid and hospital stay compared to conventional pain management.

Citations

Citations to this article as recorded by

Immunological changes and recovery-related factors in older patients with colon cancer: A pilot trial
Byeo Lee Lim, Young Il Kim, Jong Lyul Lee, Chan Wook Kim, Yong Sik Yoon, Yousun Ko, Kyung Won Kim, In Ja Park
Journal of Geriatric Oncology.2025; 16(3): 102200. CrossRef
Multimodal analgesia for postoperative pain: pursuing liberation from pain, not redemption
Soo Yeun Park
Annals of Coloproctology.2024; 40(3): 189. CrossRef
Clinical outcomes and future directions of enhanced recovery after surgery in colorectal surgery: a narrative review
Ji Hyeong Song, Minsung Kim
The Ewha Medical Journal.2024;[Epub] CrossRef
Optimizing postoperative pain management in minimally invasive colorectal surgery
Soo Young Lee
Annals of Coloproctology.2024; 40(6): 525. CrossRef

Benign GI diease,Benign diesease & IBD,Postoperative outcome & ERAS,Minimally invasive surgery

Comparing the Postoperative Outcomes of Single-Incision Laparoscopic Appendectomy and Three Port Appendectomy With Enhanced Recovery After Surgery Protocol for Acute Appendicitis: A Propensity Score Matching Analysis: Won Jong Kim, Hyeong Yong Jin, Hyojin Lee, Jung Hoon Bae, Wooree Koh, Ji Yeon Mun, Hee Ju Kim, In Kyu Lee, Yoon Suk Lee, Chul Seung Lee; Ann Coloproctol. 2021;37(4):232-238. Published online September 30, 2020; DOI: https://doi.org/10.3393/ac.2020.09.15

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Abstract PDF

Purpose
The objective of this study was to compare the perioperative outcomes between single-incision laparoscopic appendectomy (SILA) and 3-port conventional laparoscopic appendectomy (CLA) in enhanced recovery after surgery (ERAS) protocol.
Methods
Of 101 laparoscopic appendectomy with ERAS protocol cases for appendicitis from March 2019 to April 2020, 54 patients underwent SILA with multimodal analgesic approach (group 1) while 47 patients received CLA with multimodal analgesic approach (group 2). SILA and CLA were compared with the single institution’s ERAS protocol. To adjust for baseline differences and selection bias, operative outcomes and complications were compared after propensity score matching (PSM).
Results
After 1:1 PSM, well-matched 35 patients in each group were evaluated. Postoperative hospital stays for patients in group 1 (1.2 ± 0.8 vs. 1.6 ± 0.8 days, P = 0.037) were significantly lesser than those for patients in group 2. However, opioid consumption (2.0 mg vs. 1.4 mg, P=0.1) and the postoperative scores of visual analogue scale for pain at 6 hours (2.4±1.9 vs. 2.8 ± 1.4, P = 0.260) and 12 hours (2.4 ± 2.0 vs. 2.9 ± 1.5, P = 0.257) did not show significant difference between the 2 groups.
Conclusion
SILA resulted in shortening the length of hospitalization without increase in complications or readmission rates compared to CLA with ERAS protocol.

Citations

Citations to this article as recorded by

Swedish national guidelines for diagnosis and management of acute appendicitis in adults and children
Martin Salö, Catarina Tiselius, Anders Rosemar, Elin Öst, Sara Sohlberg, Roland E Andersson
BJS Open.2025;[Epub] CrossRef
Perioperative outcomes of laparoscopic low anterior resection using ArtiSential® versus robotic approach in patients with rectal cancer: a propensity score matching analysis
I. K. Kim, C. S. Lee, J. H. Bae, S. R. Han, W. Alshalawi, B. C. Kim, I. K. Lee, D. S. Lee, Y. S. Lee
Techniques in Coloproctology.2024;[Epub] CrossRef
Challenging issues of implementing enhanced recovery after surgery programs in South Korea
Soo-Hyuk Yoon, Ho-Jin Lee
Anesthesia and Pain Medicine.2024; 19(1): 24. CrossRef
A Single Site Approach to Appendicitis: A Review of a Single Center
Yoshito Tsuji, Yujiro Nishizawa, Yuki Ozato, Akira Inoue, Yoshinori Kagawa
Nippon Daicho Komonbyo Gakkai Zasshi.2024; 77(3): 161. CrossRef
The “Hansol-roll” folding method for placement of self-gripping (ProGrip™) mesh in single-port inguinal hernia repair using ArtiSential®
Gwan Chul Lee, Dong Woo Kang, Choon Sik Chung, Chul Seung Lee
Asian Journal of Surgery.2024; 47(7): 3272. CrossRef
Comparison between liquid skin adhesive and wound closure strip for skin closure after subcuticular suturing in single-port laparoscopic appendectomy: a single-center retrospective study in Korea
Kyeong Eui Kim, Yu Ra Jeon, Sung Uk Bae, Woon Kyung Jeong, Seong Kyu Baek
Journal of Minimally Invasive Surgery.2024; 27(1): 14. CrossRef
Progress in Clinical Treatment of Uncomplicated Acute Appendicitis in Children
珊白
Advances in Clinical Medicine.2024; 14(04): 471. CrossRef
Single-incision laparoscopic total extraperitoneal inguinal-hernia repair using the new articulating instruments: A video vignette
Chul Seung Lee, Gwan Chul Lee, Choon Sik Chung, Dong Keun Lee
Asian Journal of Surgery.2024; 47(8): 3586. CrossRef
Single-incision versus conventional multi-incision laparoscopic appendicectomy for suspected uncomplicated appendicitis
Ahmer Irfan, Ahsan Rao, Irfan Ahmed
Cochrane Database of Systematic Reviews.2024;[Epub] CrossRef
Clinical Outcomes of Single-incision Laparoscopic Appendectomy Versus Conventional Laparoscopic Appendectomy in Adult Acute Appendicitis
SHINTARO KOHAMA, KUNIHIKO NAGAKARI, MASAKAZU OHUCHI, KAZUHIRO TAKEHARA, KUMPEI HONJO, SHUN ISHIYAMA, KIICHI SUGIMOTO, SHINICHI OKA, JIRO YOSHIMOTO, MASAKI FUKUNAGA, YOICHI ISHIZAKI, KAZUHIRO SAKAMOTO
Juntendo Medical Journal.2024; 70(6): 436. CrossRef
Risk factors for prolonged hospitalization and delayed treatment completion after laparoscopic appendectomy in patients with uncomplicated acute appendicitis
Jiyoung Shin, Myong Hoon Ihn, Kyung Sik Kim, Sang Hyun Kim, Jihyoun Lee, Sangchul Yun, Sung Woo Cho
Annals of Coloproctology.2023; 39(1): 50. CrossRef
A prospective randomized controlled study comparing patient-reported scar evaluation of single-port versus multiport laparoscopic appendectomy for acute appendicitis
Kyeong Eui Kim, In Soo Cho, Sung Uk Bae, Woon Kyung Jeong, Hyung Jin Kim, Seong Kyu Baek
Journal of Minimally Invasive Surgery.2023; 26(2): 55. CrossRef
The Latest Results and Future Directions of Research for Enhanced Recovery after Surgery in the Field of Colorectal Surgery
Min Ki Kim
The Ewha Medical Journal.2023;[Epub] CrossRef
Analyzing the conversion factors associated with switching from a single-incision, one-puncture procedure to a two-site, three-port procedure in pediatric laparoscopic appendectomy
Keisuke Yano, Mitsuru Muto, Toshio Harumatsu, Taichiro Nagai, Masakazu Murakami, Chihiro Kedoin, Ayaka Nagano, Mayu Matsui, Koshiro Sugita, Shun Onishi, Koji Yamada, Waka Yamada, Makoto Matsukubo, Tatsuru Kaji, Satoshi Ieiri
Journal of Pediatric Endoscopic Surgery.2022; 4(2): 49. CrossRef
Laparoscopic Appendectomy Using the Surgical-Glove Port Through an Umbilical Incision: A Single-Center Retrospective Study
Tran Que Son, Tran Hieu Hoc, Vu Duc Long, Tran Thanh Tung, Nguyen Minh Tuan, Bui Minh Hue, Nguyen Van Minh, Nguyen Toan Thang
Cureus.2022;[Epub] CrossRef
Single-port robotic totally extraperitoneal(TEP) inguinal hernia repair using the da Vinci SP platform: A video vignette
Dongjun Kim, Chul Seung Lee
Asian Journal of Surgery.2022; 45(10): 2062. CrossRef
Single-incision compared with conventional laparoscopy for appendectomy in acute appendicitis: a systematic review and meta-analysis
Changjia Li, Yukun Liu, Yumin Jiang, Yongjing Xu, Zhiwei Wang
International Journal of Colorectal Disease.2022; 37(9): 1925. CrossRef
Enhanced recovery after surgery pathways for patients undergoing laparoscopic appendectomy
Abhijit Nair, Hamed Humayid Mohammed Al-Aamri, Osama Azmy Ishaq, Parwez Waseemul Haque
Journal of Acute Disease.2022; 11(5): 173. CrossRef
Robot-Assisted Colorectal Surgery
Young Il Kim
The Ewha Medical Journal.2022;[Epub] CrossRef
Enhanced recovery after surgery: importance of compliance audits
Jung Hoon Bae
Journal of the Korean Medical Association.2021; 64(12): 820. CrossRef

Review

Benign proctology

Metronidazole in the Management of Post-Open Haemorrhoidectomy Pain: Systematic Review: Angelina Di Re, James Wei Tatt Toh, Jonathan Iredell, Grahame Ctercteko; Ann Coloproctol. 2020;36(1):5-11. Published online February 29, 2020; DOI: https://doi.org/10.3393/ac.2020.01.08

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Abstract PDF

Purpose
Open haemorrhoidectomy is associated with significant postoperative pain. Metronidazole is commonly prescribed in the postoperative period as an adjunct to analgesia in pain management.
Methods
In our systematic review, studies were identified using PubMed/MEDLINE, Embase/Ovid and Cochrane Register of Controlled Trials databases. Studies were included if they were randomised controlled trials (RCTs) involving interventions with oral metronidazole at any dose over any time period. The primary outcome was pain score (visual analogue scale, VAS) after open haemorrhoidectomy. Secondary outcomes included time to return to normal daily activities, additional analgesia usage, and postoperative complications.
Results
Of 14 RCTs reviewed, 4 met inclusion criteria and were selected. The studies comprised 336 study subjects and 169 subjects were randomised to metronidazole while 167 were in the control group. There was a significant reduction in VAS across all time points, with maximal reduction seen on day 5 posthaemorrhoidectomy (mean difference, -2.28; 95% confidence interval, -2.49 to -2.08; P < 0.001). There was no difference in incidence of complications (P = 0.13). The Cochrane Risk of Bias Tool showed 3 of 4 of the studies had a risk of bias.
Conclusion
Metronidazole may be associated with decreased pain but there is insufficient evidence from RCTs to provide a strong grade of recommendation. Further RCTs are required.

Citations

Citations to this article as recorded by

Role of antibiotics in Milligan-Morgan hemorrhoidectomy for Grade III to IV Hemorrhoids: A randomized clinical trial
Jiali Liu, Lei Lv, Hai-hua Qian, Ping-Liang Sun, Dan Zhang
Asian Journal of Surgery.2024; 47(1): 169. CrossRef
Topical metronidazole after haemorrhoidectomy to reduce postoperative pain: a systematic review
Chiara Eberspacher, Domenico Mascagni, Stefano Pontone, Francesco Leone Arcieri, Stefano Arcieri
Updates in Surgery.2024; 76(4): 1161. CrossRef
Conventional Excisional Haemorrhoidectomy versus Transanal Haemorrhoidal Dearterialization for Haemorrhoids: A Systematic Review and Meta-Analysis
Juliana Jee, Lauren Vourneen O’Connell, Ishapreet Kaur, Shaheel Mohammad Sahebally
Digestive Surgery.2024; 41(4): 204. CrossRef
Strategies to Reduce Post-Hemorrhoidectomy Pain: A Systematic Review
Varut Lohsiriwat, Romyen Jitmungngan
Medicina.2022; 58(3): 418. CrossRef
Topical Versus Oral Metronidazole After Excisional Hemorrhoidectomy: A Double-Blind Randomized Controlled Trial
Weisi Xia, Ahmed W.H. Barazanchi, Wiremu S. MacFater, Andrew D. MacCormick, Darren Svirskis, Tarik Sammour, Andrew G. Hill
Diseases of the Colon & Rectum.2022; 65(11): 1362. CrossRef
Treatment of Hemorrhoid in Unusual Condition-Pregnancy
Hyo Seon Ryu
The Ewha Medical Journal.2022;[Epub] CrossRef

Original Articles

Benign GI diease, Functional outcomes

The Effects of Preoperative Pain Education on the Decision to Discharge Patients Following Single-Incision Laparoscopic Appendectomy: Ji Won Seo, Moon Jin Kim, Sung-Hoon Yoon, Kwang Yeol Paik, Sun Min Park, Won Kyung Kang, Dosang Lee, Chul Seung Lee; Ann Coloproctol. 2020;36(6):398-402. Published online January 24, 2020; DOI: https://doi.org/10.3393/ac.2020.01.16

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7 Web of Science
7 Citations

Abstract PDF Supplementary Material

Purpose
Few studies have analyzed the effects of preoperative pain education on the postoperative decision to discharge. The purpose of this study was to determine the effects of pain education and management on the decision to discharge patients after single-incision laparoscopic appendectomy (SILA).
Methods
We analyzed 135 patients who had undergone SILA for acute appendicitis between March 2017 and April 2018 in a single medical center. Of these, 72 patients (53.3%) had received preoperative pain education (group 1), and 63 (46.7%) had not (group 2). We compared perioperative outcomes and complications between the groups.
Results
Baseline characteristics of sex, age, body mass index, American Society of Anesthesiologist score, and systemic inflammation factors (neutrophil-lymphocyte ratio, C-reactive protein level) did not differ significantly between the groups. There were no postoperative complications for patients in either group. Perioperative consequences and pathologic findings were not significantly different between the groups; however, length of hospital was significantly shorter in group 1.
Conclusion
Preoperative pain education in relation to postoperative pain management influenced the decision to shorten the postoperative hospital length of stay after SILA.

Citations

Citations to this article as recorded by

Perioperative outcomes of laparoscopic low anterior resection using ArtiSential® versus robotic approach in patients with rectal cancer: a propensity score matching analysis
I. K. Kim, C. S. Lee, J. H. Bae, S. R. Han, W. Alshalawi, B. C. Kim, I. K. Lee, D. S. Lee, Y. S. Lee
Techniques in Coloproctology.2024;[Epub] CrossRef
Effect of continuous wound infiltration on patients using intravenous patient-controlled analgesia for pain management after reduced-port laparoscopic colorectal surgery
Hyeon Deok Choi, Sung Uk Bae
Annals of Coloproctology.2024; 40(6): 564. CrossRef
Relationship Between Appendectomy Incidence and Computed Tomography Scans Based on Korean Nationwide Data, 2003–2017
Ki Bum Park, Jinwook Hong, Jong Youn Moon, Jaehun Jung, Ho Seok Seo
Journal of Korean Medical Science.2022;[Epub] CrossRef
Wound Irrigation Using Wet Gauze May Reduce Surgical Site Infection Following Laparoscopic Appendectomy
Abdullah Al-Sawat, Ji Yeon Mun, Sung Hoon Yoon, Chul Seung Lee
Frontiers in Surgery.2022;[Epub] CrossRef
Surgical rectus sheath block combined with multimodal pain management reduces postoperative pain and analgesic requirement after single-incision laparoscopic appendectomy: a retrospective study
Won Jong Kim, Ji Yeon Mun, Hee Ju Kim, Sung-Hoon Yoon, Seung-Rim Han, Jung Hoon Bae, In Kyu Lee, Yoon Suk Lee, Do Sang Lee, Chul Seung Lee
International Journal of Colorectal Disease.2021; 36(1): 75. CrossRef
Clinical effect of multimodal perioperative pain management protocol for minimally invasive colorectal cancer surgery: Propensity score matching study
Chul Seung Lee, Soo Ji Park, Sang Hyun Hong, Jung-Woo Shim, Min Suk Chae, Seung-Rim Han, Jung Hoon Bae, In Kyu Lee, Dosang Lee, Yoon Suk Lee, Seong Taek Oh
Asian Journal of Surgery.2021; 44(2): 471. CrossRef
Comparing the Postoperative Outcomes of Single-Incision Laparoscopic Appendectomy and Three Port Appendectomy With Enhanced Recovery After Surgery Protocol for Acute Appendicitis: A Propensity Score Matching Analysis
Won Jong Kim, Hyeong Yong Jin, Hyojin Lee, Jung Hoon Bae, Wooree Koh, Ji Yeon Mun, Hee Ju Kim, In Kyu Lee, Yoon Suk Lee, Chul Seung Lee
Annals of Coloproctology.2021; 37(4): 232. CrossRef

Morphine Spinal Block Anesthesia in Patients Who Undergo an Open Hemorrhoidectomy: A Prospective Analysis of Pain Control and Postoperative Complications: Hélio Moreira, José PT Moreira, Raniere R Isaac, Onofre Alves-Neto, Thiago AC Moreira, Tiago HM Vieira, Andressa MS Brasil; Ann Coloproctol. 2014;30(3):135-140. Published online June 23, 2014; DOI: https://doi.org/10.3393/ac.2014.30.3.135

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Abstract PDF

Purpose

This study evaluated the use of adding morphine to bupivacaine in spinal anesthesia for pain control in patients who underwent an open hemorrhoidectomy.

Methods

Forty patients were prospectively selected for an open hemorrhoidectomy at the same institution and were randomized into two groups of 20 patients each: group 1 had a spinal with 7 mg of heavy bupivacaine associated with 80 µg of morphine (0.2 mg/mL). Group 2 had a spinal with 7 mg of heavy bupivacaine associated with distilled water, achieving the same volume of spinal infusion as that of group 1. Both groups were prescribed the same pain control medicine during the postoperative period. Pain scores were evaluated at the anesthetic recovery room and at 3, 6, 12, and 24 hours after surgery. Postoperative complications, including pruritus, nausea, headaches, and urinary retention, were also recorded.

Results

There were no anthropometric statistical differences between the two groups. Pain in the anesthetic recovery room and 3 hours after surgery was similar for both groups. However, pain was better controlled in group 1 at 6 and 12 hours after surgery. Although pain was better controlled for group 1 after 24 hours of surgery, the difference between the groups didn't achieved statistical significance. Complications were more common in group 1. Six patients (6/20) presented coetaneous pruritus and 3 with (3/20) urinary retention.

Conclusion

A hemorrhoidectomy under a spinal with morphine provides better pain control between 6 and 12 hours after surgery. However, postoperative complications, including cutaneous pruritus (30%) and urinary retention (15%), should be considered as a negative side of this procedure.

Citations

Citations to this article as recorded by

Pulmonary complications after intrathecal morphine administration: a systematic review and meta‐analysis with meta‐regression and trial sequential analysis
Kariem El‐Boghdadly, Yves Renard, Jean‐Benoit Rossel, Eleni Moka, Thomas Volk, Narinder Rawal, Cécile Jaques, Marta Szyszko, Eric Albrecht
Anaesthesia.2025;[Epub] CrossRef
Intradermal methylene blue analgesic application in posthemorrhoidectomy pain management: a randomized controlled trial
Ramin Azhough, Pooya Jalali, Mohammad Reza Dashti, Sahar Taher, Ali Aghajani
Frontiers in Surgery.2024;[Epub] CrossRef
The effect of bupivacaine on analgesia and safety in patients undergoing hemorrhoidectomy: a meta-analysis
Haixia Lu, Min Cai, Dongxi Zhou, Weiwei Li, Hanzhong Cao
Frontiers in Pharmacology.2024;[Epub] CrossRef
Non-pulmonary complications of intrathecal morphine administration: a systematic review and meta-analysis with meta-regression
Yves Renard, Kariem El-Boghdadly, Jean-Benoît Rossel, Alexandre Nguyen, Cécile Jaques, Eric Albrecht
British Journal of Anaesthesia.2024; 133(4): 823. CrossRef
Ten-year multicentric retrospective analysis regarding postoperative complications and impact of comorbidities in hemorrhoidal surgery with literature review
Cosmin Moldovan, Elena Rusu, Daniel Cochior, Madalina Elena Toba, Horia Mocanu, Razvan Adam, Mirela Rimbu, Adrian Ghenea, Florin Savulescu, Daniela Godoroja, Florin Botea
World Journal of Clinical Cases.2023; 11(2): 366. CrossRef
The Assessment of Marcaine Versus Meperidine for Spinal Anesthesia in Anorectal Surgery: A Randomized Clinical Trial
Mehran Rezvani Habibabadi, Masumeh Safaee, Ali Rezaei
Anesthesiology and Pain Medicine.2023;[Epub] CrossRef
Strategies to Reduce Post-Hemorrhoidectomy Pain: A Systematic Review
Varut Lohsiriwat, Romyen Jitmungngan
Medicina.2022; 58(3): 418. CrossRef
Non-Doppler hemorrhoidal artery ligation and hemorrhoidopexy combined with pudendal nerve block for the treatment of hemorrhoidal disease: a non-inferiority randomized controlled trial
Konstantinos Perivoliotis, Michail Spyridakis, Elias Zintzaras, Eleni Arnaoutoglou, Manousos-Georgios Pramateftakis, Konstantinos Tepetes
International Journal of Colorectal Disease.2021; 36(2): 353. CrossRef
The effect of adding morphine to intratecal bupivacaine on postoperative analgesia in patients with perianal surgery
Münire BABAYİĞİT
Anatolian Current Medical Journal.2021; 3(2): 124. CrossRef
Endogenous Opiates and Behavior: 2015
Richard J. Bodnar
Peptides.2017; 88: 126. CrossRef
Evidence‐Based Management of Pain After Excisional Haemorrhoidectomy Surgery: A PROSPECT Review Update
Tarik Sammour, Ahmed W. H. Barazanchi, Andrew G. Hill, Francis Bonnet, Barrie Fischer, Girish Joshi, Henrik Kehlet, Philipp Lirk, Narinder Rawal, Stephan Schug, Marc Van de Velde, Marcel Vercauteren
World Journal of Surgery.2017; 41(2): 603. CrossRef
Prolonged Opioid-Sparing Pain Control after Hemorrhoidectomy with Liposome Bupivacaine: Results from a Cohort of 95 Patients
Allen B. Jetmore, Douglas Hagen
Pain Studies and Treatment.2016; 04(01): 5. CrossRef
Spinal Block Anesthesia With Morphine in a Hemorrhoidectomy
Byung Chun Kim
Annals of Coloproctology.2014; 30(3): 107. CrossRef

Postoperative Pain Relief Using Wound Infiltration With 0.5% Bupivacaine in Single-Incision Laparoscopic Surgery for an Appendectomy: So Ra Ahn, Dong Baek Kang, Cheol Lee, Won Cheol Park, Jeong Kyun Lee; Ann Coloproctol. 2013;29(6):238-242. Published online December 31, 2013; DOI: https://doi.org/10.3393/ac.2013.29.6.238

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Abstract PDF

Purpose

Recently, single-incision laparoscopic surgery (SILS) has been popular for minimally invasive surgery and cosmetic improvement. However, some papers have reported that SILS for an appendectomy (SILS-A) has had the more postoperative complaints of pain. We investigated postoperative pain relief using wound infiltration with 0.5% bupivacaine in SILS-A and compared the result with that for conventional SILS-A.

Methods

Between July 2010 and September 2012, 75 patients who underwent SILS-A were enrolled in this study. The patients were randomly assigned to two groups: conventional SILS-A group (C-SILS-A) or wound infiltrated with 0.5% bupivacaine in SILS-A group (W-SILS-A). Forty-five patients were in the C-SILS-A, and 30 patients were in the W-SILS-A. Patients with perforated appendicitis were excluded. The clinical outcomes were compared between the groups by using the verbal numerical rating scale (VNRS).

Results

Clinical outcomes were similar in both study groups except for the pain score. The W-SILS-A group showed significantly lower numbers of additional pain killers and lower VNRS scores 1, 6, and 12 hours after surgery than the C-SILS-A group.

Conclusion

W-SILS-A is a technically simple and effective method of reducing early postoperative pain. It may be applicable in SILS-A for pain control system.

Citations

Citations to this article as recorded by

Transversus abdominis plane block for laparoscopic cholecystectomy in short-term acute care hospital
V.V. Bedin, V.Yu. Vengerov, O.V. Makarov, N.I. Koroleva, K.A. Loginov, V.L. Polianskii, F.G. Pilyus
Pirogov Russian Journal of Surgery.2024; (12): 13. CrossRef
Clinical Outcomes of Single-incision Laparoscopic Appendectomy Versus Conventional Laparoscopic Appendectomy in Adult Acute Appendicitis
SHINTARO KOHAMA, KUNIHIKO NAGAKARI, MASAKAZU OHUCHI, KAZUHIRO TAKEHARA, KUMPEI HONJO, SHUN ISHIYAMA, KIICHI SUGIMOTO, SHINICHI OKA, JIRO YOSHIMOTO, MASAKI FUKUNAGA, YOICHI ISHIZAKI, KAZUHIRO SAKAMOTO
Juntendo Medical Journal.2024; 70(6): 436. CrossRef
Updates on Wound Infiltration Use for Postoperative Pain Management: A Narrative Review
Dusica M. Stamenkovic, Mihailo Bezmarevic, Suzana Bojic, Dragana Unic-Stojanovic, Dejan Stojkovic, Damjan Z. Slavkovic, Vladimir Bancevic, Nebojsa Maric, Menelaos Karanikolas
Journal of Clinical Medicine.2021; 10(20): 4659. CrossRef
Determination of the efficacy of ultrasound-guided bilateral transversus abdominis plane (US-TAP) block in laparoscopic total extraperitoneal (TEP) repair of unilateral hernia surgeries: A randomized controlled trial
Vijayalakshmi Sivapurapu, SriVengadesh Gopal, Ashley Solomon
Journal of Anaesthesiology Clinical Pharmacology.2021; 37(3): 475. CrossRef
Effect of bupivacaine on postoperative pain and analgesics use after single-incision laparoscopic appendectomy: double-blind randomized study
Heon-Kyun Ha, Kyung-Goo Lee, Kang Kook Choi, Wan Sung Kim, Hyung Rae Cho
Annals of Surgical Treatment and Research.2020; 98(2): 96. CrossRef
Unilateral transversus abdominis plane block and port-site infiltration
Emine Arık, T. Akkaya, S. Ozciftci, A. Alptekin, Ş. Balas
Der Anaesthesist.2020; 69(4): 270. CrossRef
Effect of Local Anesthesia on the Postoperative Pain After Laparoscopic Appendectomy
Samir Čustovic, Haris Pandža, Samir Delibegovic
Journal of Laparoendoscopic & Advanced Surgical Techniques.2019; 29(1): 65. CrossRef
Diagnosis and management of acute appendicitis. EAES consensus development conference 2015
Ramon R. Gorter, Hasan H. Eker, Marguerite A. W. Gorter-Stam, Gabor S. A. Abis, Amish Acharya, Marjolein Ankersmit, Stavros A. Antoniou, Simone Arolfo, Benjamin Babic, Luigi Boni, Marlieke Bruntink, Dieuwertje A. van Dam, Barbara Defoort, Charlotte L. Dei
Surgical Endoscopy.2016; 30(11): 4668. CrossRef
Is transverse abdominis plane block effective following local anesthetic infiltration in laparoscopic totally extraperitoneal hernia repair?
Mun Gyu Kim, Soon Im Kim, Si Young Ok, Sang Ho Kim, Se-Jin Lee, Sun Young Park, Jae-Hwa Yoo, Ana Cho, Kyung Yul Hur, Myung Jin Kim
Korean Journal of Anesthesiology.2014; 67(6): 398. CrossRef
Preemptive Analgesia in Single-Incision Laparoscopic Surgery
Eui Gon Youk
Annals of Coloproctology.2013; 29(6): 221. CrossRef

The Usefulness of a Harmonic Scalpel(R) for Hemorrhoidectomy.: Choe, Kyu Hyung , Kim, Yu Yong , Chang, Eu Myung; J Korean Soc Coloproctol. 2002;18(1):10-14.

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Abstract PDF: PURPOSE
The aim of this study was to compare conventional scissors and Harmonic Scalpel(R) hemorrhoidectomy.
METHODS
Two hundred and five patients were prospectively assigned to two groups in the consecutive order. The group was divided into Group A (Harmonic Scalpel(R) excision; n=101) and Group B (conventional scissor excision; n=104). All other aspects of surgery and anesthesia were standardized. Intramuscular opiate was available on demand during the postoperative period, and analgesic requirements were also recorded. All patients noted their pain on a daily basis using a visual analogue scale (0=no pain; 10=worst pain). The length of hospitalization, operative time and postoperative complications were also analyzed.
RESULTS
The operative time was 16.6 +/- 0.9 minutes 25.3 +/- 0.8 minutes in Group A and B, respectively (p<0.01). Length of hospital stay was 4.1 +/- 0.1 and 4.5 +/- 0.1 days (p<0.05). Pain scores in the group A were significantly lower than in the group B (p<0.01). Analgesic requirements were also significantly less in group A (p<0.05). Postoperative complications, such as urinary retention, fecal impaction and skin tags were rarer in group A. One patient in group A and two patients in group B developed secondary hemorrhage, but no patient had anal stricture.
CONCLUSIONS
The Harmonic Scalpel(R) excision significantly shortens the operative time for hemorrhoidectomy with less blood loss and postoperative pain without remarkable early or late postoperative complications.

Randomized Controlled Trial

Effects of Intraoperative Injection of Tarasyn for Pain Relief on Patients Undergoing Hemorrhoidectomy: Result of a prospective, randomized trial.: Kim, Min Chan , Choi, Hong Jo; J Korean Soc Coloproctol. 2000;16(6):371-375.

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Abstract PDF: PURPOSE
The aim of this prospective study was to evaluate whether additional intraoperative injection of Tarasyn (ketorolac tromethamine) provided a preemptive analgesic effect that improved postoperative pain.
METHODS
Sixty patients scheduled for hemorrhoidectomy were randomly assigned to the study and control groups. For the control group (n=32), patients were treated with standard intravenous injections of Nubain (Nalbuphine hydrochloride; Jeil Pharmaceuticals Co, Seoul) per 8 hours for three times postoperatively for pain relief. In the study group (Tarasyn group, n=28), 60 mg of Tarasyn (ketorolac tromethamine; Roche Korea, Seoul) was injected into the internal sphincter muscle and around the operative wound at the time of hemorrhoidectomy as well as standard intravenous injections of Nubain . Parameters were measured of pain score from 0 (no pain) to 10 (agonizing pain), painless sound sleep, additional analgesic requirements, time to first bowel movement, and postoperative urinary retention.
RESULTS
Rate of painless sound sleep was 75.0% and 53.1% in the Tarasyn and the control groups, respectively, which was significant statically between two groups (P<0.05). Time to first bowel movement was 2 and 3.2 days in Tarasyn and the control groups, respectively, which was also significant statistically (P<0.05). Voiding difficulty developed in one case (3.5%) in the Tarasyn group and he needed catheterization. In the control group, however, the number (15 cases, 46.9%; P<0.001) was much higher requiring more catherization (13 cases, 40.9%; P<0.001). Mean pain scores was significant statically between two groups (P<0.001).
CONCLUSION
The data suggest that the use of intraoperative injection of Tarasyn is associated with a significant decrease in pain and urinary complications after hemorrhoidectomy.

Original Article

Intraoperative Muscular Injection of Tarasyn(R) for Postoperative Hemorrhoidectomy Pain Management.: Kim, Kuhn Uk , Park, Weon Kap , Lee, Kwang Real , Yoo, Jung Jun , Lim, Seok Won , Kim, Hyun Shig , Lee, Jong Kyun; J Korean Soc Coloproctol. 1998;14(2):269-274.

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Abstract PDF: The pain after a hemorrhoidectomy is widely feared by many patients who are mostly still treated with oral/intramuscular narcotics to control their pain postoperatively. In an effort to decrease posthemorrhoidectomy pain by applying newer methods of analgesia, a prospective trial was conducted to investigate the postoperative analgesic effect of Tarasyn(R) (ketorolac tromethamine) injected into the internal sphincter muscle at the time of the hemorrhoidectomy. Tarasyn(R) is a nonsteroidal anti-inflammatory drug introduced for intramuscular injection to control postoperative pain. It's action is peripheral. Therefore, it seems appropriate to inject it directly into the anal sphincter muscles when these are exposed during anorectal procedures. A total loading dose of 60 mg(2 cc, 30 mg/ml) of ketorolac was used intraoperatively. It was injected intramuscularly locally after completion of hemorrhoidectomy. Postoperative pain after a hemorrhoidectomy can be safely controlled in a patient by using newer methods of pain control, including supplemental use of the nonsteroidal analgesic ketorolac, which allows early release of the patient, the day of surgery by diminishing the postoperative pain in our study group. Another important advantage of a local injection of ketorolac was the elimination of urinary retention.

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