title: Manometric study of the anal sphincter during haemorrhoidectomy using posterior perineal block.
abstract: Minor anorectal diseases affect 4-5% of the adult western population. Operations are performed on an ambulatory or 24-hour-stay basis. The aim of our study was to assess the physiology of anal sphincter relaxation by anal manometry after posterior perineal block during haemorrhoidectomy. We recruited 15 patients with third and fourth degree hemorrhoids in a manometric study of the anal sphincter during haemorrhoidectomy with regional anaesthesia. The patients underwent anal manometry before and 15 minutes after the posterior perineal block to determine the resting and squeeze anal pressures. Differences were considered significant at p < 0.05. We observed mean reductions of 34.6% and 37.1% in resting and squeeze pressure values, respectively, after posterior perineal block (p < 0.005). Our manometric study demonstrated that anal sphincter relaxation after posterior perineal block correlates with a significant reduction in resting and squeeze pressures because the block anaesthesia not only the somatic, but also the sympathetic fibres. We believe that posterior perineal block allows the surgeon to perform radical haemorrhoidectomy in the overnight stay setting with optimal intra- and postoperative analgesia, safe sphincter relaxation, lower postoperative complications, and lower costs to the public health service.
authors.affiliation: University of Milano, Bicocca, Department of Surgery, Istituti Clinici Zucchi, Monza.
authors.forename: Francesco
authors.initials: F
authors.lastname: Gabrielli
authors.forename: Matilde
authors.initials: M
authors.lastname: De Simone
authors.forename: Marco
authors.initials: M
authors.lastname: Chiarelli
authors.forename: Angelo
authors.initials: A
authors.lastname: Guttadauro
authors.forename: Marco
authors.initials: M
authors.lastname: Pagani
authors.forename: Marco
authors.initials: M
authors.lastname: Venturi
authors.forename: Luca
authors.initials: L
authors.lastname: Poggi
authors.forename: Michele M
authors.initials: MM
authors.lastname: Ciulla
authors.forename: Ugo
authors.initials: U
authors.lastname: Cioffi
mesh_terms: D000328:Adult; D001003:Anal Canal / Q000503:physiopathology* / Q000601:surgery; D000772:Anesthesia, Local; D005069:Evaluation Studies as Topic; D005260:Female; D006484:Hemorrhoids / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008365:Manometry; D008875:Middle Aged; D009407:Nerve Block; D010502:Perineum; D011312:Pressure