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Histological examination of circular stapled 'doughnuts': questionable routine practice?
A Morgan1, P M Dawson, J J Smith
1Dept of Colorectal Surgery, West Middlesex University Hospital, UK.
Summary
Routine histological examination of surgical doughnuts after left-sided colonic resection offers no benefit. This practice consumes valuable time and resources without impacting patient management or recurrence rates.
Area of Science:
- Colorectal surgery
- Surgical pathology
Background:
- Left-sided colonic resections frequently utilize circular staplers for anastomosis.
- Surgeons commonly submit the resulting 'doughnuts' for histological examination.
Purpose of the Study:
- To evaluate the clinical necessity of routine histological examination of doughnuts from stapled colorectal anastomoses.
- To assess the impact of doughnut histology on patient management and treatment decisions.
Main Methods:
- Retrospective review of 100 consecutive patients undergoing stapled anastomosis for colorectal cancer (1998-2004).
- Analysis of clinical records and histopathological reports of surgical doughnuts.
Main Results:
- Only 2% of doughnuts showed minor histological abnormalities (inflammatory changes, metaplastic polyp).
- No doughnut abnormalities were found in patients who experienced local recurrence.
- Histological findings did not influence subsequent patient management.
Conclusions:
- Routine histological examination of doughnuts is resource-intensive and time-consuming.
- The study demonstrates no demonstrable benefit from routine doughnut examination in this patient cohort.