Pathological audit of stapled haemorhoidopexy

Area of Science:

• Colorectal Surgery
• Surgical Pathology
• Gastroenterology

Background:

• Stapled haemorrhoidopexy is a common surgical treatment for prolapsing haemorrhoids.
• Accurate staple line placement is crucial to prevent complications like internal anal sphincter (IAS) injury and pain from squamous epithelium involvement.
• This study aimed to correlate histological findings with patient outcomes after stapled haemorrhoidopexy.

Purpose of the Study:

• To investigate the relationship between histological examination of rectal mucosal specimens and the symptomatic outcome following stapled haemorrhoidopexy.
• To determine if the presence of squamous epithelium in pathology specimens affects long-term patient symptoms or continence.

Main Methods:

• One hundred and six rectal mucosal specimens from stapled haemorrhoidopexy procedures were reviewed by a single pathologist.
• Specimens were analyzed for epithelial types (columnar, transitional, squamous) and muscle involvement (smooth, skeletal).
• Patients completed validated postal questionnaires on haemorrhoidal symptoms and the Cleveland Clinic continence scale; outcomes were compared based on squamous epithelium presence.

Main Results:

• Of 106 procedures, 84 patients returned questionnaires; 19 had squamous epithelium in their specimens.
• No significant difference in symptom scores or Cleveland Clinic continence scores was observed between patients with and without squamous epithelium.
• Involvement of the internal anal sphincter (IAS) in specimens also did not correlate with significant differences in continence scores.

Conclusions:

• The presence of squamous epithelium in stapled haemorrhoidopexy specimens does not appear to affect long-term symptomatic outcomes or patient continence.
• Histological analysis of specimens did not reveal a significant correlation with patient-reported symptoms or continence levels post-surgery.