Mid-term results of stapled hemorrhoidopexy for third- and fourth-degree hemorrhoids--correlation with the histological features of the resected tissue.
BACKGROUND
Stapled hemorrhoidopexy is used to remove a circumferential strip of mucosa and submucosa about 4 cm above the dentate line, in order to restore the correct anatomical relationships of the anal canal structures. We evaluated the histological features of the resected tissue obtained after stapled hemorrhoidopexy with correlation to the short-term and mid-term results.


METHODS
This retrospective study evaluated 234 cases of stapled hemorrhoidopexy. Data concerning postoperative bleeding, anal pain, incontinence, stenosis, and recurrence of hemorrhoids were collected from hospital and outpatient clinic records. Histologic slides were examined for the type of epithelium, presence of muscle fibers, nerve endings, and degree of vascular ectasia.


RESULTS
Some 52% of the biopsies revealed on the surface a combination of glandular with squamous epithelium, meaning a stapling line at the level of the transitional zone/dentate line. Smooth muscle fibers were more frequent as the stapling line approached the level of the dentate line/transitional zone (p = 0.0028). Internal sphincter fibers were present in 36% of the cases, yet there were no cases of anal incontinence. Inclusion of merely squamous epithelium in the resected tissue correlated with severe postoperative pain persisting one week after surgery (p < 0.0001), whereas the concurrent presence of squamous and glandular epithelium correlated only with severe pain on the first postoperative day (p = 0.018). Nerve endings were more frequent in patients with anal pain one week after surgery (p = 0.02). The rate of recurrence of symptoms was 3%, which did not correlate with any of the histological parameters tested.


CONCLUSIONS
Though stapled hemorrhoidopexy is performed according to well-established technical guidelines, it is too difficult to be standardized.
Ohana
Gil
G
Proctology Unit, Hasharon Hospital, 7 Keren Kayemet St., Petach Tikva, Israel. gil_oha@zahav.net.il
Myslovaty
Boris
B
Ariche
Arie
A
Dreznik
Zeev
Z
Koren
Rumelia
R
Rath-Wolfson
Lea
L
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006484:Hemorrhoids / Q000473:pathology / Q000601:surgery*; D006801:Humans; D007413:Intestinal Mucosa / Q000294:innervation / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009130:Muscle, Smooth / Q000473:pathology / Q000601:surgery; D009411:Nerve Endings / Q000473:pathology / Q000601:surgery; D010149:Postoperative Pain / Q000473:pathology / Q000601:surgery; D011183:Postoperative Complications / Q000209:etiology / Q000473:pathology; D012005:Rectal Prolapse / Q000473:pathology / Q000601:surgery*; D012008:Recurrence; D012189:Retrospective Studies; D013223:Statistics as Topic; D013528:Surgical Staplers