Histopathology and Physiological Alterations After Procedure for Prolapsed Hemorrhoids

cle, rather than the internal sphincter, may be injured during a PPH because it is recommended to perform the procedure two to five centimeters above the dentate line [7]. If the staple line is at the level of the dentate line and the specimen involves smooth muscle, one can conclude that an injury to the internal sphincter happened during the PPH. However, there was no change in continence, not even in cases where an injury to the internal sphincter was highly suspected because the smooth muscles had been resected from the anal sphincter region. On the other hand, there have been reports that these inadvertent histological findings may be a cause of pain, tenesmus, or fecal urgency [8]. Although the PPH is devised to remove mucosa and submucosa, smooth muscle in PPH specimens is a frequently-observed finding whose clinical significance is unclear. However, any injury to the continuity of the bowel or sphincter mechanism may lead to serious complications, such as retroperitoneal abscess, dehiscence, or deterioration of continence. Therefore, taking care not to injure the internal sphincter or the rectum so as to prevent unexpected serious complications is reasonable.