Stapled haemorrhoidopexy: correlation among histology, intraoperative morphology and interindividual anatomic variability in muco-haemorrhoidal prolapse.

PURPOUSE The Authors correlated intraoperative mucohaemorrhoidal prolapse morphology, specimen histology, anal canal length and purse-string height. METHODS Between September-November 2010, 18 patients (9 grade III; 9 grade IV haemorrhoids) underwent stapled haemorrhoidopexy. Mean age was 54 years (range 38-78).Proctoscopic prolapse morphology, anal canal length, pursestring height and external component were evaluated intraoperatively and specimens sent for histology. RESULTS Intraoperative findings were as follows: 2/18 patients showed no procidentia, 2/18 'haemorrhoid type' prolapse, 14/18 'rectal type' prolapse. Mean anal canal lenght was 3.5 cm (range 2.5-4.5); mean purse-string height was 4.5 cm from the dentate line (range 3.5-5.5); 10/18 patients carried external component. Histology showed mucosa/submucosa in 4/18 cases, muscolaris propria in 9/18, perivisceral fat in 5/18. No procidentia/'haemorrhoid type' prolapse showed only mucosa/submucosa at histolgy; a 'rectal type' morphology showed at least the muscolaris propria. An anal canal > 3.5 cm related to 'haemorrhoid type' prolapse, a pursestring ≤ 4 cm and mucosa/submucosa at histology. An anal canal ≤ 3.5 cm related to 'rectal type' prolapse, a purse string > 4 cm from dentate line and at least the muscolaris propria. One patient required analgesics for >7 days. At three months, 1/18 patient presented urgency, 2/18 stool clustering. In 1/18 patient a moderate grade of external component persisted. DISCUSSION A possible correlation among anoscopic phenotype, specimen histology, pursestring height, might exist and influence clinical outcomes. CONCLUSIONS A positive correlation between specimen thickness, purse-string height and 'rectal type' morphology was found. Patients with higher anal canal showed haemorrhoidal pattern of prolapse, a lower purse-string and mucosa/submucosa at histology.Intraoperative prolapsing tissue morphology could represent a further criteria for surgical decision.