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Introduction: Conventional Hemorrhoidectomy (CH) is well known to cause significant postoperative pain and delayed return to daily activities. Both surgical wounds and sphincterial apparatus spasms are likely responsible for the pain. Besides internal sphincter spasm and hypertonia are associated with impaired mucosal blood flow and probably with delayed healing. In this study we evaluated the role of Glyceryl Trinitrate Ointment (GTN) in reducing postoperative pain, ameliorating wound healing and recovery after CH.Patients and methods: Between 01/08 and 05/09, 54 symptomatic patients were randomly assigned to receive (23 patients) or not (31 patients) 0.4% GTN ointment for 8 weeks after radiofrequency hemorrhoidectomy. Patients with inflammatory bowel disease, coexisting anorectal disease, or previous anal surgery were excluded. Patients were seen 1 week after Day Surgery, and pain assessed using a 10 centimeters linear visual analogue scale (VAS). Further controls were at 1, 3 and 6 months after surgery or if required. Clinical outcome was assessed by a validated questionnaire on postoperative symptoms and satisfaction supplemented by the Wexner continence score. Data on postoperative pain (including intensity and duration), wound secretion and healing, bleeding, return to normal activities and early (<30 days) and late (>30 days) complications were recorded and prospectively entered in a database. Data were analysed using Fisher exact and Mann-Whitney tests. Results: Patients groups were similar in terms of mean age, gender distribution, degree of disease and follow-up. GTN treated group experienced significantly less pain during the first week after surgery (3.9+/-2.1 vs. 5.3+/-2, p 0.02, expressed as mean VAS score). This difference was more evident starting postoperative day 4. A significant higher percentage of untreated patients experienced severe pain (mean VAS score>7) (6.6+/-4.4 vs 12.1+/-6.5, p 0.009). Despite no differences were observed in terms of bleeding, soiling and itching duration, patients treated with GTN were able to an early return to daily activities compared to untreated (11.5+/-4 days vs 16+/-9.2 p<0.05). Two GTN treated patients (8.7%) discontinued the application because of local discomfort and headache. The two groups were similar in terms of ER admission, hospital readmissions, and overall early and late complications. Patients’ satisfaction scores were also similar.Conclusions: Topical GTN crème reduces postoperative pain after hemorrhoidectomy and, despite we did not observe a significant effect on wound healing, it allows an early return to daily activities.