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World Journal of Surgery

, Volume 31, Issue 6, pp 1338–1344 | Cite as

Mid-term Results of Stapled Hemorrhoidopexy for Third- and Fourth-degree Hemorrhoids—Correlation with the Histological Features of the Resected Tissue

  • Gil Ohana
  • Boris Myslovaty
  • Arie Ariche
  • Zeev Dreznik
  • Rumelia Koren
  • Lea Rath-Wolfson
Article

Abstract

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.

Keywords

Nerve Ending Hemorrhoid Squamous Epithelium Anal Incontinence Dentate Line 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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Copyright information

© Société Internationale de Chirurgie 2007

Authors and Affiliations

  • Gil Ohana
    • 1
    • 2
    • 4
  • Boris Myslovaty
    • 1
    • 4
  • Arie Ariche
    • 2
    • 4
  • Zeev Dreznik
    • 1
    • 2
    • 4
  • Rumelia Koren
    • 3
    • 4
  • Lea Rath-Wolfson
    • 3
    • 4
  1. 1.Proctology UnitHasharon HospitalPetach TikvaIsrael
  2. 2.Division of Surgeryasharon HospitalPetach TikvaIsrael
  3. 3.Department of PathologyHasharon HospitalPetach TikvaIsrael
  4. 4.Sackler Faculty of MedicineTel-Aviv UniversityTel AvivIsrael

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