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Introduction: Various pain management strategies for patients undergoing open excisional hemorrhoidectomy have been proposed, yet postoperative pain remains a frequent complaint., Objective: To determine whether mesoglycan (30 mg two vials i.m. once/day for the first 5 days postoperative, followed by 50 mg 1 oral tablet twice/day for 30 days) would reduce the edema of the mucocutaneous bridges and thus improve postoperative pain symptoms., Patients and Methods: For this prospective observational multicenter study, 101 patients undergoing excisional diathermy hemorrhoidectomy for III-IV degree hemorrhoidal disease were enrolled at 5 colorectal referral centers. Patients were assigned to receive either mesoglycan (study group SG) or a recommended oral dose of ketorolac tromethamine of 10 mg every 4-6 hours, not exceeding 40 mg per day and not exceeding 5 postoperative days according to the indications for short-term management of moderate/severe acute postoperative pain, plus stool softeners (control group CG)., Results: Postoperative thrombosis (SG 1/48 versus CG 5/45) ( p < 0.001) and pain after rectal examination ( p < 0.001) were significantly reduced at 7-10 days after surgery in the mesoglycan-treated group, permitting a faster return to work ( p < 0.001); however, in the same group, the incidence of postoperative bleeding, considered relevant when needing a readmission or an unexpected outpatient visit, was higher, possibly owing to the drug's antithrombotic properties., Conclusions: The administration of mesoglycan after an open diathermy excisional hemorrhoidectomy can reduce postoperative thrombosis and pain at 7-10 days after surgery, permitting a faster return to normal activities.

Background: The aim of this paper was to report our personal experience in the endoscopic treatment of chronic venous insufficiency associated with incompetent perforating veins., Methods: In the region of 400 cases of chronic venous insufficiency, classified using the new CEAP criteria, were treated over the course of one year at the General Surgery unit of Ospedale SS. Trinità in Fossano (Cuneo). Of these, 47 patients, classified between C2 and C6, underwent endoscopic treatment of insufficient perforating veins showing persistent or recidivating trophic ulcerative lesions; radical internal saphenectomy was associated in 30 cases., Results: The results were reappraised at 12, 10, 8, 6, 4, 2 and 1 month, and trophic lesions had already healed after 5 weeks in 35 patients. There was a marked clinical improvement and a noticeable change in quality of life in 10 patients, whereas treatment failed in 2 cases. No cases of recidivation have been reported in the patients who were successfully treated, but in spite of an improvement in cutaneous skin trophism, there were persistent dyschromic lesions in 40 patients who underwent SEPS., Conclusions: Having compared our experience with that of other authors, we conclude that SEPS is undoubtedly an effective method for the surgical treatment of chronic venous insufficiency with incompetent perforating veins. However, it is harder to establish the real role played by SEPS when treatment is associated with saphenectomy. In view of this, we regard SEPS as a "complementary" treatment forming part of a wider therapeutic context.

The case of a 27-year-old woman, admitted to our surgical ward with symptoms of epigastric-ache, postmeal vomiting and significant weight loss, is reported. Clinical and radiographic suspicion of mesenterium commune, with duodenal compression due to bands, requested an explorative laparatomy that confirmed the mesenterium commune presence with left caecum and colon adhesion and left Bochdaleck hernia, which is rare in adult age.