Background: This study aims to investigate the best pharmacological treatment for postoperative pain after hemorrhoidectomy. Material and Methods: This prospective non-randomized study included 5335 patients who underwent hemorrhoidectomy from July 2016 to December 2020, divided into two groups: "around-the-clock" analgesic treatment (ACAT) with 3,767 participants, and "on-demand" analgesic treatment (ODAT) with 1568 participants. Results: The mean age was 47.47 years old, 59.98% male. Postoperatively, severe pain was reported by 14.13% of the patients, moderate pain in 36.49%, mild pain in 34.28%, and no pain in 15.09%. In the ACAT group, the mean for maximum pain was 3.04 on the Visual Analogue Scale (VAS) and 4.95 for the ODAT group. The average pain in the ACAT group was 0.79 VAS and for the ODAT group 1.45 VAS. The pain at the time of discharge was 0.42 (SD±0.730) VAS for the ACAT group and 0.63 (SD±0.799) VAS for the ODAT group. Comparing the three modalities of pain measurement, the ACAT group reported significantly less pain (p<.001). Having a higher BMI and being younger were risk factors for pain (p=.049, and p<.001, respectively). The ACAT group used significantly fewer opioids, which decreased the use of meperidine by 68.38% less; morphine by 43.57%, tramadol by 46.82%; 38.74% oxycodone; and codeine by 53.40% less. The need for non-opioid analgesics was also lower in the ACAT group, between 16-59% less than in the ODAT group. Conclusion: Hemorrhoidectomy induces moderate postoperative pain and only 14% of the patients suffer severe pain. A fixed schedule multimodal pain regime diminishes pain from moderate to mild after hemorrhoidectomy, independent of procedure and anesthesia type, thereby reducing the doses of opioids needed from between 38 to 68%, and reducing the dosage of non-opiates as well. Higher BMI and youngest age were recognized as risk factors for higher postoperative pain. Trial registration clinicaltrials.gov (NCT04953182). Available at: https://clinicaltrials.gov/ct2/show/NCT04953182

Background Extreme obesity leads to increased health risks and perioperative complications. The results of bariatric surgery in patients with super-super obesity (SSO) are presented in this study. Methods From April 2008 to August 2019, 60 patients with SSO underwent bariatric surgery. Their weight loss and surgical outcome were analyzed. The mean follow-up time was 7.2 years. Results At baseline, the mean age was 41.5 years old, the mean BMI was 63.8 kg/m2, 80% of the patients suffered from co-morbidities, and 23.33% were revisional surgeries. Weight loss continued for up to two years after surgery. The percentage of EBW lost at two years was 62.27%, from two to five years: 61.48%, from five to 10 years: 36.82% and after ten years it was 31.89%, the differences in weight change over the time is significative (P<.001). The mean BMI at last visit (Mean 7.2 years) was 45.1 kg/m2 and 48.33% of the patients failed to lose at least 50% of EBW. Patients with fatty liver, diabetes, sleep apnea and hyperlipidemia had a remission or improvement in more than 70% of the cases. There were 5% perioperative complications, one perioperative death (1.67%) and other patient died in a motor vehicle accident, overall mortality 3.33%. Conclusion In the long term, almost half of the patients failed to lose 50% of their EBW. However, the metabolic effects of bariatric surgery were maintained during the follow-up time with a high remission of comorbidities. Revisional bariatric surgery increased the risk of mortality.

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