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Stapled Hemorrhoidopexy: A Prospective Study From Pathology to Clinical Outcome

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Journal of Gastrointestinal Surgery Aims and scope

Abstract

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.

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References

  1. Roswell M, Bello M, Hemingway DM. Circumferential mucosectomy versus conventional haemorrhoidectomy: randomised controlled trial. Lancet 2000;355:779–781.

    Article  Google Scholar 

  2. Ganio E, Altomare DF, Gabrielli F, Milito G, Canuti S. Prospective randomized multicentre trial comparing stapled and open haemorrhoidectomy. Br J Surg 2002;88:669–674.

    Article  Google Scholar 

  3. Slawik S, Kenefick N, Greenslade L, Dixon AR. A prospective evaluation of stapled haemorrhoidopexy/rectal mucosectomy in the management of 3rd and 4th degree haemorrhoids. Colorectal Dis 2006;9:352–356.

    Article  Google Scholar 

  4. Finco C, Sarzo G, Savastano S, Degregori S, Merigliano S. Stapled haemorrhoidopexy in fourth degree haemorrhoidal prolapse: is it worthwhile? Colorectal Dis 2005;8:130–134.

    Article  Google Scholar 

  5. McCloud JM, Jameson JS, Scott ND. Life-threating sepsis following treatment for haemorrhoids: a systematic review. Colorectal Dis 2006;8:748–755.

    Article  PubMed  CAS  Google Scholar 

  6. Longo A. Treatment of haemorrhoids disease by reduction of mucosa and haemorrhoidal prolapse with a circular suturing device: a new procedure. In: Proceedings of the 6th World Congress of Endoscopic Surgery, Rome, 1998, pp 777–784.

  7. George BD, Shetty D, Lindsey I, Mortensen NJ, Warren BF. Histopathology of stapled haemorrhoidectomy specimens: a cautionary note. Colorectal Dis 2001;4:473–476.

    Article  Google Scholar 

  8. Beattie GC, McAdam TK, McIntosh SA, Loudon MA. Day case stapled haemorrhoidopexy for prolapsing haemorrhoids. Colorectal Dis 2005;8:56–61.

    Article  Google Scholar 

  9. Kanellos I, Zacharakis E, Kanellos D, Pramateftakis MG, Tsachalis T, Betsis D. Long-term results after stapled haemorrhoidopexy for third-degree haemorrhoids. Tech Coloproctol 2006;10:47–49.

    Article  PubMed  CAS  Google Scholar 

  10. Mlakar B, Kosorok P. Complications and results after stapled haemorrhoidopexy as a day surgical procedure. Tech Coloproctol 2003;7:164–168.

    Article  PubMed  CAS  Google Scholar 

  11. McDonald PJ, Bona R, Cohen CRG. Rectovaginal fistula after stapled haemorrhoidopexy (letter). Colorectal Dis 2004;6:64–65.

    Article  PubMed  CAS  Google Scholar 

  12. Corman ML, Graviè JF, Hager T, Loudon MA, Mascagni D, et al. Stapled haemorrhoidopexy: a consensus position paper by an international working party-indications, contra-indications and technique. Colorectal Dis 2003;5:304–310.

    Article  PubMed  CAS  Google Scholar 

  13. Shanmugam V, Watson AJM, Chapman AD, Binnie NR, Loudon A. Pathological audit of stapled haemorrhoidopexy. Colorectal Dis 2004;7:172–175.

    Article  Google Scholar 

  14. Ho Y-H, Seow-Cohen F, Tsang C, Eu K-W. Randomized trial assessing anal sphincter injuries after stapled haemorrhoidectomy. Br J Surg 2001;88:1449–1455.

    Article  PubMed  CAS  Google Scholar 

  15. Oughriss M, Yver R, Faucheron JL. Complications of stapled haemorrhoidectomy: a French multicentric study. Gastroenterol Clin Biol 2005;29:429–433.

    Article  PubMed  Google Scholar 

  16. Ravo B, Amato A, Bianco V et al. Complications after stapled haemorrhoidectomy: can they be prevented? Tech Coloproctol 2003;6:83–88.

    Article  Google Scholar 

  17. Cheetham MJ, Cohen CR, Kamm MA, Philips RKS. A randomised, controlled trial of diathermy haemorrhoidectomy in an intended day-care setting with longer-term follow-up. Dis Colon Rectum 2003;46:491–497.

    Article  PubMed  CAS  Google Scholar 

  18. Filingeri V, Gravante G. Stapled haemorrhoidopexy followed by fecal urgency and tenesmus: methodological complication or surgeon’s mistake? Tech Coloproctol 2006;10:149–153.

    Article  PubMed  CAS  Google Scholar 

  19. Brusciano L, Ayabaca SM, Pescatori M et al. Reinterventions after complicated or failed stapled haemorrhoidopexy. Dis Colon Rectum 2004;47:1846–1851.

    Article  PubMed  CAS  Google Scholar 

  20. Cheetham MJ, Mortensen NJ, Nystrom PO, Kamm MA, Philips RKS. Persistent pain and fecal urgency after stapled haemorroidectomy. Lancet 2000;26:730–733.

    Article  Google Scholar 

  21. Shalaby R, Desoky A. Randomized clinical trial of stapled versus Milligan–Morgan haemorrhoidectomy. Br J Surg 2001;88:1049–1053.

    Article  PubMed  CAS  Google Scholar 

  22. Ortiz H, Marzo J, Armendariz P. Randomised clinical trial of stapled haemorrhoidopexy versus conventional diathermy haemorrhoidectomy. Br J Surg 2002;89:1376–1381.

    Article  PubMed  CAS  Google Scholar 

  23. Goulimaris I, Kanellos I, Christoforidis E, Mantzoros I, Odisseos CD. Stapled haemorrhoidectomy compared with Milligan–Morgan excision for treatment of prolapsing haemorrhoids: a prospective study. Eur J Surg 2002;168:621–625.

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Surgery, University of Rome Tor Vergata, Rome, Italy

    Pierpaolo Sileri, Vito Maria Stolfi, Alessandra Mele, Alessandro Falchetti, Sara Di Carlo & Achille Lucio Gaspari

  2. Department of Pathology, University of Rome Tor Vergata, Rome, Italy

    Giampiero Palmieri

  3. Policlinico Tor Vergata, 6B, Viale Oxford 81, 00133, Rome, Italy

    Pierpaolo Sileri

Authors
  1. Pierpaolo Sileri
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  2. Vito Maria Stolfi
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  3. Giampiero Palmieri
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  4. Alessandra Mele
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  5. Alessandro Falchetti
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  6. Sara Di Carlo
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  7. Achille Lucio Gaspari
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Correspondence to Pierpaolo Sileri.

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Sileri, P., Stolfi, V.M., Palmieri, G. et al. Stapled Hemorrhoidopexy: A Prospective Study From Pathology to Clinical Outcome. J Gastrointest Surg 11, 1662–1668 (2007). https://doi.org/10.1007/s11605-007-0328-3

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  • DOI: https://doi.org/10.1007/s11605-007-0328-3

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