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Is routine pathologic evaluation of hemorrhoidectomy specimens necessary?
Nicolas Lemarchand1, Florence Tanne, Manuel Aubert
1Service de colo-proctologie, Hôpital Léopold Bellan, 19/21 rue Vercingetorix, 75014 Paris. nlemarchand@noos.fr
Gastroenterologie Clinique Et Biologique
|January 14, 2005
Summary
Routine histological examination of hemorrhoidectomy specimens is not useful and costly. Only suspicious areas identified preoperatively or during surgery warrant gross and microscopic evaluation to avoid unnecessary analysis.
Area of Science:
- Coloproctology
- Surgical Pathology
Background:
- The French Society of Coloproctology proposed that routine histological study of hemorrhoidectomy specimens is unnecessary.
- This study aimed to evaluate the utility of systematic histological examination of hemorrhoidectomy specimens.
Purpose of the Study:
- To confirm or refute the assertion that systematic histological examination of hemorrhoidectomy specimens is not useful.
Main Methods:
- Retrospective analysis of 8153 hemorrhoidectomy specimens from a coloproctology unit (1985-2001).
- Histological examination of specimens with normal gross appearance.
- Analysis of specimens associated with anal fissure or suppuration.
Main Results:
- 56 histological abnormalities (0.69%) were found in specimens with normal gross appearance.
- Three cases of intraepithelial neoplasia (0.04%) and four of severe dysplasia (0.05%) were identified.
- Specimens with anal fissure or suppuration showed no increased rate of histological lesions.
Conclusions:
- Routine pathological evaluation of hemorrhoidectomy specimens is not useful and incurs significant costs.
- Proctology procedures should adopt a similar approach, avoiding routine analysis.
- Suspicious areas identified preoperatively or intraoperatively should undergo targeted gross and microscopic evaluation.