title: Excision of residual skin tags during stapled anopexy does not increase postoperative pain.
abstract: OBJECTIVE
  We studied whether excision of residual external skin tags causes additional pain in patients undergoing a stapled anopexy for muco-anal prolapse.
  
  
  METHODS
  Seventeen patients in whom skin tags had been excised were compared with 24 patients having no excision. The patients were selected from a prospective database of haemorrhoid surgery if they had submitted a diary with self-reported postoperative pain scores as well as a self-reported symptom questionnaire preoperatively and postoperatively. The tags were excised with preservation of the subdermal fascia.
  
  
  RESULTS
  There were 41 patients who fulfilled the criteria for inclusion. Seventeen (group 1) had tags excised and 24 (group 2) did not. Fifty-nine per cent in group 1 and 67% in group 2 experienced preoperative prolapse needing manual reposition. The mean height of the staple line was 2 cm above the dentate line in both groups. Daily average postoperative pain recorded as the sum of a self-reported VAS rating over 14 days was 26 points in both groups. The peak pain experienced was 42 and 43 points respectively (not significant). Resolution of postoperative pain over 14 days was identical. The preoperative and postoperative symptom score was comparable in both groups.
  
  
  CONCLUSIONS
  Excision of anal skin tags should be carried out at the time of stapled anopexy.
authors.affiliation: Colorectal Surgery, Department of Surgery, Linköping University Hospital, Linköping, Sweden.
authors.forename: R
authors.initials: R
authors.lastname: Gerjy
authors.forename: P O
authors.initials: PO
authors.lastname: Nyström
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006484:Hemorrhoids / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain; D012871:Skin Diseases / Q000601:surgery*