Abstract
Introduction: Stapled hemorrhoidopexy was originally defined as a rectal mucosectomy. The aims of our retrospective, single-center study were to demonstrate if the excised specimen comprises only the mucosa or more wall rectal layers and if the latter excision should be considered a technical mistake with an increase in complications.Materials and Methods: We histopathologically analyzed surgical samples from patients who underwent stapled hemorrhoidopexy performed between 2014 and 2019. Patients were divided into three groups, according to the stapler used: Group A (single PPH®), Group B (double PPH®), and Group C (CPH34 HV™). We evaluated the actual wall layers included in the stapled rectal ring. For every specimen, we reconstructed the history of the corresponding patient and the incidence of complications.Results: Of the 137 histological slides available, 13 were only mucosectomies (9.5%), and 124 presented also the submucosa and muscularis propria (90.5%)−50/58 patients in Group A, 28/28 in Group B, and 46/51 in Group C. No statistically significant difference in the rate of complications was found when stratifying patients according to the thickness of the resection [mucosectomy (M) or “full thickness” (FT)].Discussion: Stapled hemorrhoidopexy is not a simple mucosectomy but a resection of the rectal wall with almost all its layers. This concept defines the entity of the surgical procedure and excludes a direct correlation with an increased rate of complications.
Highlights
Stapled hemorrhoidopexy was originally defined as a rectal mucosectomy
We identified a total of 304 stapled hemorrhoidopexy (SH) procedures performed in our Department of Surgical Sciences of “Sapienza” University of Rome that met our inclusion criteria
We identified a true mucosectomy in eight patients (13.7%) in Group A, none in Group B (0%), and five (9.8%) in Group C (Table 1)
Summary
The aims of our retrospective, single-center study were to demonstrate if the excised specimen comprises only the mucosa or more wall rectal layers and if the latter excision should be considered a technical mistake with an increase in complications. The procedure gained in popularity thanks to its creator Antonio Longo, who, in his report on this stapled hemorrhoidopexy (SH) [3], described the object of the excision as a rectal internal mucosal prolapse. The aim of the present study is to evaluate, during SH, despite the different techniques and tips or tricks of the surgeons, if the stapled ring include only the mucosa or it is a “full-thickness” excision and if the latter feature should be considered a technical mistake, increasing the complication rate
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