Background and Aims: Morbid obesity is an emerging problem in inflammatory bowel disease (IBD) population. Bariatric and IBD surgeries share technical difficulties and elevated morbidity. However, nothing is known about the possibility of performing bariatric surgery in patients with a definite diagnosis of IBD. Aim of this study was to evaluate safety and efficacy of restrictive bariatric surgical procedures in IBD patients. Methods: Six patients with morbid obesity and IBD were operated on with restrictive bariatric surgery and concomitant or deferred IBD surgery. We compared BMI, excess weight loss, and perioperative complications of restrictive bariatric surgery in IBD with a control group of 95 bariatric patients. We also evaluated clinical, biochemical, pharmacological, and endoscopic characteristics before and after surgery in IBD patients. Results: Perioperative results, in terms of BMI, excess weight loss and complications after restrictive bariatric surgery, were comparable between obese IBD and control patients. IBD patients experienced a significant postoperative reduction in BMI, CRP levels, WCC, and systolic blood pressure and a significant increment in haemoglobin levels. None of the patients reported signs of malabsorption. All the patients, except one, were able to discontinue steroids, were in endoscopic remission at 1 year, and in clinical remission at the last follow-up visit. Two patients halved azathioprine dosage. One patient had a postoperative clinical recurrence treated with Adalimumab. Conclusions: Bariatric surgery seems to be safe and effective in IBD patients. Concomitant ileo-colic resection does not increase perioperative complications. Relationship between IBD and obesity remains unclear, but weight loss could be useful in the pharmacological control of IBD.

: Anal post-operative pain is one of the principal issues of surgical treatment of hemorrhoids and remains a distressing problem, for patients and physicians. : Recent studies have concluded that appropriate postoperative pain management leads to higher patient satisfaction, earlier mobilization, fewer drug complications, eliminated adverse events, faster recovery, and decreased health care cost. : However, despite advances in pain medicine, postoperative pain control remains problematic and remains an important unresolved issue that causes expense and patient dissatisfaction. Therefore, this situation calls for multi-modal pain management, choosing medication, dosing regimens and route of administration in an individualized way to optimize efficacy and minimize adverse effects. : Multiple approaches, including pharmacological and surgical interventions, have been used to manage pain after hemorrhoidal surgery. : Our aim was to check the latest instruments and strategies available in literature designed to find practical solutions to this challenging problem.