Eberspacher Chiara, Magliocca Fabio M, Pontone Stefano, Mascagni Pietro, Fralleone Lisa, Gallo Gaetano, Mascagni Domenico
Department of Surgical Sciences, University of Rome 'Sapienza', Rome, Italy.
Department of Radiological Sciences, Oncology, and Pathological Anatomy, University of Rome 'Sapienza', Rome, Italy.
Front Surg. 2021 Mar 12;8:655257. doi: 10.3389/fsurg.2021.655257. eCollection 2021.
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. 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. 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)]. 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.
吻合器痔上黏膜环切术最初被定义为直肠黏膜切除术。我们这项回顾性单中心研究的目的是证实切除标本是否仅包含黏膜或更多的直肠壁层，以及如果切除了后者是否应被视为技术失误并导致并发症增加。我们对2014年至2019年间接受吻合器痔上黏膜环切术患者的手术样本进行了组织病理学分析。根据使用的吻合器，将患者分为三组：A组（单PPH®）、B组（双PPH®）和C组（CPH34 HV™）。我们评估了吻合直肠环中实际包含的壁层。对于每个标本，我们重建了相应患者的病史和并发症发生率。在137张可用的组织学切片中，13张仅为黏膜切除术（9.5%），124张还呈现了黏膜下层和固有肌层（90.5%）——A组58例患者中的50例、B组28例患者中的28例、C组51例患者中的46例。根据切除厚度（黏膜切除术（M）或“全层”（FT））对患者进行分层时，并发症发生率没有统计学上的显著差异。吻合器痔上黏膜环切术不是简单的黏膜切除术，而是几乎包含所有直肠壁层的切除术。这一概念定义了手术操作的实体，并排除了与并发症发生率增加的直接关联。
