To the Editor—We read with interest the article by Plocek et al.1 We would like to clarify several issues regarding the article.

First, the dentate line is a very fine line with variable visibility. It is difficult to make a clear distinction between 1 mm and 2 mm. We wonder how accurately this measurement was taken. It was stated that the measurement of staple height was taken by the primary colorectal surgeon on one side and the contralateral side was taken by colorectal fellow. The study involved two institutions, two colorectal surgeons, and some fellows during a period of more than two years (27 months). This certainly will introduce appreciable interobserver differences and variations in measurement of the staple height.

Second, the authors concluded that a staple line of ≥22 mm above dentate line correlates with a significantly shorter need for postoperative narcotics and an earlier return to work. We would like to ask what happens to those patients with a staple height of 21 mm or 20 mm? How clear is the difference in the postoperative outcome between a patient with a 21-mm and another with a 22-mm staple height?

Third, for the patient characteristics shown in Table 1, under category staple height (mm), it seems that only 46 (9 + 4 + 33) patients had their measurement taken. What happened to the remaining 29 patients?

Last, acute urinary retention was not reported as a postoperative complication in the study of 75 patients. In a study by our institution of 3,711 stapled hemorrhoidectomies,2 acute retention was the most common complication. An incidence of 4.9 percent was recorded.