Stapled hemorrhoidopexy: a prospective study from pathology to clinical outcome

Stapled hemorrhoidopexy is widely accepted to treat hemorrhoids, but serious complications have been reported. In this prospective audit, we correlated clinical outcome with pathological findings. From January 2003 to April 2007, 94 patients underwent hemorrhoidopexy. Macroscopic appearance of the s...

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Bibliographic Details
Published in:Journal of gastrointestinal surgery 2007-12, Vol.11 (12), p.1662-1668
Main Authors: Sileri, Pierpaolo, Stolfi, Vito Maria, Palmieri, Giampiero, Mele, Alessandra, Falchetti, Alessandro, Di Carlo, Sara, Gaspari, Achille Lucio
Format: Article
Language:English
Subjects:
Adult
Aged
Digestive System Surgical Procedures
Epithelium - pathology
Female
Hemorrhoids - pathology
Hemorrhoids - surgery
Humans
Male
Middle Aged
Muscular system
Pain
Pain Measurement
Pathology
Postoperative Complications - epidemiology
Prospective Studies
Recurrence
Smooth muscle
Surgical Stapling
Treatment Outcome
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Summary:Stapled hemorrhoidopexy is widely accepted to treat hemorrhoids, but serious complications have been reported. In this prospective audit, we correlated clinical outcome with pathological findings. From January 2003 to April 2007, 94 patients underwent hemorrhoidopexy. Macroscopic appearance of the specimen (shape, size, and depth) was recorded. Microscopically, the presence of columnar, transitional, and squamous epithelium, the involvement of circular/longitudinal smooth muscle, and features of mucosal prolapse were assessed. Clinical outcome was evaluated by a validated questionnaire. Postoperative pain, secretion, and bleeding durations were 12.7+/-10.6, 5.6+/-9.6, and 6.3+/-8.4 days. Patient's return to work averaged 16.7+/-10.7 days. Fissure, skin tags, and anal strictures were observed in 23.4%. Seven patients experienced pain for a significantly longer period of time. All specimens contained columnar mucosa, but 29.8% contained columnar and transitional epithelium and 12.8% contained columnar, anal transitional, and stratified squamous epithelium. Smooth muscle was observed in 62.7%. Pain was significantly increased if transitional epithelium was present in the specimen. No correlation or differences were observed if smooth muscle was present, although postoperative bleeding was more frequent. Hemorrhoidopexy is safe and effective. The specimen should always be sent for pathology examination. Only columnar epithelium should be present and, although the presence of smooth muscle does not influence the outcome in terms of functional results, its presence may play a role in postoperative bleeding.
ISSN:1091-255X
1873-4626
DOI:10.1007/s11605-007-0328-3