title: Histological examination of circular stapled 'doughnuts': questionable routine practice?
abstract: BACKGROUND
  Left-sided colonic resections are often anastomosed by the use of the circular stapling gun. Most surgeons routinely submit the resulting set of 'doughnuts' for histological examination.
  
  
  OBJECTIVE
  The aim of this study is to question the need for this practice by providing our own experience of the impact of 'doughnut' submission on patient management.
  
  
  METHODS
  Patients who had undergone a stapled anastomosis for colorectal cancer resection (1998-2004) were identified from the department cancer database and clinical records and histopathological reports were reviewed for all cases.
  
  
  RESULTS
  From a consecutive series of 100 sets of doughnuts only two showed histological abnormality (inflammatory change and a metaplastic polyp). Three patients had local recurrence over the follow-up period: 12, 14 and 36 months after surgery. Histological review of the 'doughnuts' in these patients did not show any abnormality. None of the above findings had any influence on subsequent management.
  
  
  CONCLUSIONS
  Histological examination of the 'doughnuts' has a considerable impact in terms of time and resource use. This study has shown no benefit in performing routine histological examination of the 'doughnuts'.
authors.affiliation: Dept of Colorectal Surgery, West Middlesex University Hospital, UK.
authors.forename: A
authors.initials: A
authors.lastname: Morgan
authors.forename: P M
authors.initials: PM
authors.lastname: Dawson
authors.forename: J J
authors.initials: JJ
authors.lastname: Smith
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology* / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical; D003110:Colonic Neoplasms / Q000473:pathology* / Q000601:surgery; D003362:Cost-Benefit Analysis; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology; D017792:Surgical Stapling; D006113:United Kingdom / Q000453:epidemiology