Correlation of Histology With Anorectal Function Following Stapled Hemorrhoidectomy

Kam, Ming Hian; Mathur, Pawan; Peng, Xudong; Seow‐Choen, Francis; Chew, Ivy; Kumarasinghe, M. Priyanthi

doi:10.1007/s10350-005-0046-4

Cited by 32 publications

(23 citation statements)

References 8 publications

(10 reference statements)

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“…Presence of malpighian tissue may be a less precise indicator of staple line height as its superior limit varies above the dentate line [17], explaining why this criterion was not related to new onset incontinence symptoms in our patients. Neither was the presence of smooth muscle fibers, as they probably issue from the rectal muscular wall above the internal sphincter [18,19]. The other factors associated with incontinence (surgeon, doughnut <12 mm, congestive external hemorrhoids) were probably linked: doughnut height was lower when resection was 332 performed near the dentate line, due to a lesser submucosa elasticity at this level, the purse string was performed lower when external hemorrhoids were present in an attempt to reduce them, and one of the three surgeons voluntarily made low resections involving most of the hemorrhoidal tissue.…”

Section: Discussionmentioning

confidence: 97%

Low hemorrhoidopexy staple line does not improve results and increases risk for incontinence

Pigot¹,

Dao-Quang

Castinel³

et al. 2006

Tech Coloproctol

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Section: Discussionmentioning

confidence: 97%

Low hemorrhoidopexy staple line does not improve results and increases risk for incontinence

Pigot¹,

Dao-Quang

Castinel³

et al. 2006

Tech Coloproctol

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“…A too-deep purse-string with incorporation of muscle cells may be related to rare but severe complications such as rectal perforation and rectovaginal fistula [8], and has been correlated with postoperative pain [9], and a trend towards a worse quality of life [10]. Removal of only anorectal mucosa without smooth muscle is difficult even in experienced hands and may be achieved in only 6% patients [10].…”

Section: Discussionmentioning

confidence: 98%

Videoanoscope-assisted stapled haemorrhoidopexy: analysis of 18 patients

et al. 2008

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An optimal stapled haemorrhoidopexy requires the purse-string suture to be placed circumferentially at a constant distance from the dentate line and to pass through an appropriate thickness of rectal mucosa. An unsuitable purse-string suture may increase the risk of postoperative complications. We developed a new anoscope (the videoanoscope) to prevent the difficulties during application of the purse-string suture, and we used the videoanoscope in 18 stapled haemorrhoidopexy procedures. The videoanoscope is made up of three pieces. The front part is in the form of an open half-cylinder. The second piece is a sliding lid that covers the front piece. The rear part of the anoscope includes a hollow handle in which a scope can be inserted, and the whole procedure can be transmitted to a monitor via this scope. The opening on the anoscope can be adjusted by sliding the lid. A purse-string suture is placed on the rectal mucosa protruding through this adjustable opening. The anoscope is rotated to apply the subsequent suture bites and when the starting point is reached again the purse-string is completed. Then the stapled haemorrhoidopexy procedure is continued in the usual fashion. Videoanoscope-assisted stapled haemorrhoidopexy was easily performed in 18 patients (12 men, 6 women; mean age 48.9 years). The mean operative time was 32.8 minutes. The excised rectal mucosal rings were complete in all of the patients. Optimal purse-string depth was reflected in the presence of only mucosa and submucosa in all specimens, without incorporation of muscle cells. Postoperative complications were urinary retention in one patient and bleeding in five patients, one of whom requiring sutures for haemostasis. Further studies are required to assess the potential advantages of this technique.

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“…Kam et al [28] showed that some smooth muscle is invariably excised in SHP but the amount of smooth muscle removed did not significantly affect the continence score, quality of life, or mean anal resting pressure after SHP. With a decrease in rectal compliance, volume thresholds for sensations decrease causing rectal urgency and/or increased stool frequency [29].…”

Section: Fecal Urgency and Incontinencementioning

confidence: 99%