AUTHOR=Eberspacher Chiara , Magliocca Fabio M. , Pontone Stefano , Mascagni Pietro , Fralleone Lisa , Gallo Gaetano , Mascagni Domenico 

TITLE=Stapled Hemorrhoidopexy: “Mucosectomy or Not Only Mucosectomy, This Is the Problem”

JOURNAL=Frontiers in Surgery

VOLUME=8

YEAR=2021

URL=https://www.frontiersin.org/journals/surgery/articles/10.3389/fsurg.2021.655257

DOI=10.3389/fsurg.2021.655257

ISSN=2296-875X

ABSTRACT=<p><bold>Introduction:</bold> 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.</p><p><bold>Materials and Methods:</bold> 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.</p><p><bold>Results:</bold> 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)].</p><p><bold>Discussion:</bold> 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.</p>