{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,23]],"date-time":"2026-04-23T21:50:25Z","timestamp":1776981025060,"version":"3.51.4"},"reference-count":27,"publisher":"Georg Thieme Verlag KG","issue":"03","license":[{"start":{"date-parts":[[2022,8,24]],"date-time":"2022-08-24T00:00:00Z","timestamp":1661299200000},"content-version":"vor","delay-in-days":54,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Surg J (N Y)"],"published-print":{"date-parts":[[2022,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>\n          Background\u2003Stapled hemorrhoidopexy is widely practiced worldwide since its introduction to the world of proctology and replaced conventional hemorrhoidectomy in treating hemorrhoids. The technique of executing the procedure dictates the outcomes and complications. Here, we attempted to establish the cause of postoperative complications and attributed them to the presence of muscle of fibers in the excised doughnut specimens.<\/jats:p><jats:p>\n          Materials and Methods\u2003A prospective observational analysis of histopathological specimens obtained from patients who underwent stapled hemorrhoidopexy using procedure for prolapse and hemorrhoids-03 circular staplers in the department of surgery of a tertiary care hospital in southern India was performed, and the correlation between the presence or absence of muscle fibers in the specimens and postoperative complications was evaluated. The patients were followed up for 12 months after the procedure.<\/jats:p><jats:p>\n          Results\u2003In this study, 155 patients, including 54, 91, and 10 patients with Grade 2, Grade 3, and Grade 4 hemorrhoids, respectively, were included. Group A consisted of 19 patients with muscle fibers on the specimens, whereas Group B consisted of 139 patients without muscle fibers on the specimens. Early complications within 7 days after the procedure were as follows: 21 and 0.7% of the patients in Groups A and B, respectively, presented with postoperative pain with a visual analog scale score of more than 4; 47 and 6% of the patients in Groups A and B, respectively, presented with urinary retention; 26 and 2% of the patients in Groups A and B, respectively, presented with bleeding; and 21 and 2.9% of the patients in Groups A and B, respectively, presented with fecal urgency. A significant association was found between the presence of muscle fibers and early complications (p\u2009&lt;\u20090.001). Late complications, such as proctalgia and bleeding, accounting for 36.8 and 6.6% in Groups A and B, respectively, were significantly associated with the presence of muscle fibers in histopathology (p\u2009&lt;\u20090.001). Meanwhile, other late complications, such as incontinence, stenosis, and recurrence, exhibited no association (p\u2009&gt;\u20090.05).<\/jats:p><jats:p>\n          Conclusion\u2003The technique in taking purse-string sutures and the depth of the suture bite above the dentate line carry the utmost importance in preventing postoperative complications. Therefore, surgeons should refine their technique of appropriate depth to avoid incorporation of muscle fibers while executing the procedure.<\/jats:p>","DOI":"10.1055\/s-0042-1743520","type":"journal-article","created":{"date-parts":[[2022,8,24]],"date-time":"2022-08-24T23:18:21Z","timestamp":1661383101000},"page":"e199-e207","source":"Crossref","is-referenced-by-count":3,"title":["Association of Muscle Fibers with Histopathology in Doughnut Specimens Following Stapled Hemorrhoidopexy and Their Impacts on Postoperative Outcomes"],"prefix":"10.1055","volume":"08","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4420-0165","authenticated-orcid":false,"given":"Chetty Y. V.","family":"Narayanaswamy","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Ramaiah Medical College, Mathikere, Bangaluru, Karnataka, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"M. R.","family":"Sreevathsa","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Ramaiah Medical College, Mathikere, Bangaluru, Karnataka, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"G. Akhil","family":"Chowdari","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Ramaiah Medical College, Mathikere, Bangaluru, Karnataka, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Koteshwara","family":"Rao","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Ramaiah Medical College, Mathikere, Bangaluru, Karnataka, India"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2022,8,24]]},"reference":[{"key":"ref1","doi-asserted-by":"crossref","first-page":"145","DOI":"10.33545\/surgery.2019.v3.i2c.30","article-title":"Comparative study of management of second and third degree hemorrhoids with injection sclerotherapy using polidocanol","volume":"3","author":"R K Rathore","year":"2019","journal-title":"Int J Surg Sci"},{"issue":"02","key":"ref3","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1111\/j.1463-1318.2011.02628.x","article-title":"Prospective randomized multicentre study comparing stapler haemorrhoidopexy with Doppler-guided transanal haemorrhoid dearterialization for third-degree haemorrhoids","volume":"14","author":"A Infantino","year":"2012","journal-title":"Colorectal Dis"},{"issue":"05","key":"ref4","doi-asserted-by":"crossref","first-page":"795","DOI":"10.1007\/s11605-008-0497-8","article-title":"Treatment of hemorrhoids in day surgery: stapled hemorrhoidopexy vs Milligan-Morgan hemorrhoidectomy","volume":"12","author":"V M Stolfi","year":"2008","journal-title":"J Gastrointest Surg"},{"issue":"09","key":"ref5","doi-asserted-by":"crossref","first-page":"921","DOI":"10.1111\/j.1463-1318.2009.01893.x","article-title":"Stapled haemorrhoidopexy: 6 years' experience of a referral centre","volume":"12","author":"S Sultan","year":"2010","journal-title":"Colorectal Dis"},{"issue":"01","key":"ref6","doi-asserted-by":"crossref","first-page":"44","DOI":"10.9738\/INTSURG-D-13-00173.1","article-title":"Documented complications of staple hemorrhoidopexy: a systematic review","volume":"100","author":"L J Porrett","year":"2015","journal-title":"Int Surg"},{"key":"ref7","volume-title":"Technical tips and tricks of stapled hemorrhoidopexy","author":"J RL Wild","year":"2018"},{"key":"ref8","volume-title":"Surgery of the Anus, Rectum and Colon","author":"J C Goligher","year":"1980"},{"issue":"03","key":"ref9","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1111\/j.1463-1318.2008.01638.x","article-title":"Stapled haemorrhoidopexy for the treatment of haemorrhoids: a systematic review","volume":"11","author":"J Burch","year":"2009","journal-title":"Colorectal Dis"},{"issue":"03","key":"ref10","doi-asserted-by":"crossref","first-page":"335","DOI":"10.1007\/s00384-008-0611-0","article-title":"Stapled haemorrhoidopexy compared to Milligan-Morgan and Ferguson haemorrhoidectomy: a systematic review","volume":"24","author":"K Laughlan","year":"2009","journal-title":"Int J Colorectal Dis"},{"key":"ref11","doi-asserted-by":"crossref","first-page":"2375","DOI":"10.1016\/S0140-6736(16)31803-7","article-title":"Comparison of stapled haemorrhoidopexy with traditional excisional surgery for haemorrhoidal disease (eTHoS): a pragmatic, multicentre, randomised controlled trial","volume":"388","author":"A J Watson","year":"2016","journal-title":"Lancet"},{"issue":"02","key":"ref12","doi-asserted-by":"crossref","first-page":"180","DOI":"10.1007\/s001040051289","article-title":"[The Longo and Milligan-Morgan hemorrhoidectomy. A prospective comparative study of 300 patients]","volume":"72","author":"J J Kirsch","year":"2001","journal-title":"Chirurg"},{"issue":"05","key":"ref13","doi-asserted-by":"crossref","first-page":"601","DOI":"10.1007\/DCR.0b013e3182098df2","article-title":"Long-term results after stapled hemorrhoidopexy: a prospective study with a 6-year follow-up","volume":"54","author":"A Ommer","year":"2011","journal-title":"Dis Colon Rectum"},{"issue":"07","key":"ref14","doi-asserted-by":"crossref","first-page":"1292","DOI":"10.1007\/s11605-013-2220-7","article-title":"Stapled hemorrhoidopexy versus Milligan-Morgan hemorrhoidectomy in circumferential third-degree hemorrhoids: long-term results of a randomized controlled trial","volume":"17","author":"J S Kim","year":"2013","journal-title":"J Gastrointest Surg"},{"issue":"01","key":"ref15","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1007\/s10151-008-0391-0","article-title":"Postoperative complications after procedure for prolapsed hemorrhoids (PPH) and stapled transanal rectal resection (STARR) procedures","volume":"12","author":"M Pescatori","year":"2008","journal-title":"Tech Coloproctol"},{"issue":"08","key":"ref16","doi-asserted-by":"crossref","first-page":"1783","DOI":"10.1007\/s00268-008-9627-4","article-title":"Circular stapled hemorrhoidopexy: experience of a single center with 445 cases","volume":"32","author":"C Uras","year":"2008","journal-title":"World J Surg"},{"key":"ref17","doi-asserted-by":"crossref","first-page":"730","DOI":"10.1016\/S0140-6736(00)02632-5","article-title":"Persistent pain and faecal urgency after stapled haemorrhoidectomy","volume":"356","author":"M J Cheetham","year":"2000","journal-title":"Lancet"},{"issue":"08","key":"ref18","doi-asserted-by":"crossref","first-page":"648","DOI":"10.1016\/j.ijsu.2010.07.303","article-title":"Proctalgia as a late complication of stapled hemorrhoidectomy. Report of our case series","volume":"8","author":"B Ielpo","year":"2010","journal-title":"Int J Surg"},{"issue":"12","key":"ref19","doi-asserted-by":"crossref","first-page":"1905","DOI":"10.1007\/s10350-006-0724-x","article-title":"Hemorrhoidopexy staple line height predicts return to work","volume":"49","author":"M D Plocek","year":"2006","journal-title":"Dis Colon Rectum"},{"issue":"08","key":"ref20","doi-asserted-by":"crossref","first-page":"1033","DOI":"10.1002\/bjs.5677","article-title":"Long-term outcome of a multicentre randomized clinical trial of stapled haemorrhoidopexy versus Milligan-Morgan haemorrhoidectomy","volume":"94","author":"E Ganio","year":"2007","journal-title":"Br J Surg"},{"key":"ref21","doi-asserted-by":"crossref","first-page":"25","DOI":"10.21037\/ales.2016.11.02","article-title":"Stapled hemorrhoidopexy: no more a new technique","volume":"1","author":"P Cianci","year":"2016","journal-title":"Ann Laparosc Endosc Surg"},{"issue":"09","key":"ref22","doi-asserted-by":"crossref","first-page":"1048","DOI":"10.1111\/j.1463-1318.2010.02359.x","article-title":"Outcome of repeated stapler haemorrhoidopexy for recurrent prolapsing haemorrhoids","volume":"13","author":"I White","year":"2011","journal-title":"Colorectal Dis"},{"issue":"04","key":"ref23","doi-asserted-by":"crossref","first-page":"501","DOI":"10.1007\/s00423-007-0257-3","article-title":"Impact of stapled haemorrhoidopexy on stool continence and anorectal function: long-term follow-up of 242 patients","volume":"393","author":"S Riss","year":"2008","journal-title":"Langenbecks Arch Surg"},{"issue":"05","key":"ref24","doi-asserted-by":"crossref","first-page":"198","DOI":"10.3393\/ac.2013.29.5.198","article-title":"Correlation of histopathology with anorectal manometry following stapled hemorrhoidopexy","volume":"29","author":"Y K Hong","year":"2013","journal-title":"Ann Coloproctol"},{"key":"ref25","first-page":"2575","article-title":"Stenosis after stapled anopexy: personal experience and literature review","volume":"10","author":"I Corsale","year":"2018","journal-title":"J Surg"},{"issue":"06","key":"ref26","doi-asserted-by":"crossref","first-page":"473","DOI":"10.1046\/j.1463-1318.2002.00381.x","article-title":"Histopathology of stapled haemorrhoidectomy specimens: a cautionary note","volume":"4","author":"B D George","year":"2002","journal-title":"Colorectal Dis"},{"issue":"03","key":"ref27","doi-asserted-by":"crossref","first-page":"323","DOI":"10.1111\/j.1463-1318.2009.02160.x","article-title":"Serious unconventional complications of surgery with stapler for haemorrhoidal prolapse and obstructed defaecation because of rectocoele and rectal intussusception","volume":"13","author":"G Naldini","year":"2011","journal-title":"Colorectal Dis"},{"issue":"08","key":"ref28","first-page":"00271","article-title":"Stapled hemorrhoidopexy and long term outcomes\u2014a single center experience of 3130 cases at healing hands clinic, India","volume":"7","author":"A D Porwal","year":"2017","journal-title":"Gastroenterol Hepatol (N Y)"}],"container-title":["The Surgery Journal"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/s-0042-1743520.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,8,24]],"date-time":"2022-08-24T23:19:02Z","timestamp":1661383142000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/s-0042-1743520"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,7]]},"references-count":27,"journal-issue":{"issue":"03","published-online":{"date-parts":[[2022,8,2]]},"published-print":{"date-parts":[[2022,7]]}},"URL":"https:\/\/doi.org\/10.1055\/s-0042-1743520","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["2378-5128","2378-5136"],"issn-type":[{"value":"2378-5128","type":"print"},{"value":"2378-5136","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,7]]}}}