Hemoroidektomi Sonrası Her Spesmenin Histopatolojik İncelenmesi Gerekli mi?

Öz

Amaç: Hemoroidektomi sonrası her spesmenin patolojik incelemeye gönderilip gönderilmemesini sorgulamaktır. Gereç ve Yöntemler: Çalışmamıza, 2010-2017 yılları arasında Ankara Numune Eğitim ve Araştırma Hastanesi Genel Cerrahi Kliniğinde hemoroidektomi sonrası spesmenlerin histopatolojik incelemesi yapılan hastalar dahil edildi. Hastaların yaş, cinsiyet, operasyon tipi ve patoloji sonuçları retrospektif olarak değerlendirildi.Bulgular: Toplam 1524 hastanın 1058 % 69 ’i erkek ve 466 % 31 ’i kadındı. Hastaların ortanca yaşı 41 min:21, maks:83 idi. Hastaların histopatolojik sonuçlarına bakıldığında; tamamının benign natürde olduğu ve malignite lehine bir sonucun olmadığı görüldü.Sonuç: Serimizde malignitenin saptanmaması nedeniyle rutin spesmenin patolojik incelenmesini önermiyoruz. Cerrahi öncesi şüpheli lezyon varlığında, seçilmiş hasta grubunda spesmen incelemeye gönderilebilir

Anahtar Kelimeler

• Hemoroidal hastalık, Hemoroidektomi, Patolojik inceleme

Is Histopathological Examination of Every Specimen After Hemorrhoidectomy Necessary?

Abstract

Objective: To query whether each specimen should be sent for pathological examination after hemorrhoidectomy.Material and Methods: The study included patients who underwent histopathological examination of specimens after hemorrhoidectomy at the Ankara Numune Training and Research Hospital General Surgery Clinic between 2010 and 2017. The age, gender, type of operation and pathology results of the patients were evaluated retrospectively.Results: 1058 69% of the 1524 patients were male and 466 31% were female. The median age of the patients was 41 years min: 21, max: 83 . When the histopathological results of the patients were evaluated, it was seen that they were all benign and there was no result in favor of malignancy. Conclusion: We do not recommend pathologic examination of the routine specimens because of the absence of malignancy in our series. Lesions that look suspicious before surgery can be sent for a specific study in the selected patient group

Keywords

• Hemorrhoidal disease, Hemorrhoidectomy, Pathological examination

References

1. Grodsky L. Unsuspected carcinoma found histologically after minor anorectal operations. California Medicine 1967;106(1):44-8.
2. Val-Bernal JF, Pinto J. Pagetoid dyskeratosis is a frequent incidental finding in hemorrhoidal disease. Archives of Pathology & Laboratory Medicine 2001;125(8):1058-62.
3. Matteucci P, Pittamiglio H, Lopez-Susviela J. Anal cancer masked by benign lesions. International Surgery 1983;68(2):183-4.
4. Di Cataldo A, Latino R, Cocuzza A, Li Destri G, Lanteri R, Wachtel M, Frezza EE. Incidental rectal carcinoid discovered after stapled hemorrhoidopexy: Importance of histopathologic examination. Annali Italiani di Chirurgia 2011;82(2):155-7.
5. Cross S, Stone J. Proactive management of histopathology workloads: Analysis of the UK Royal College of Pathologists’ recommendations on specimens of limited or no clinical value on the workload of a teaching hospital gastrointestinal pathology service. Journal of Clinical Pathology 2002;55(11):850-2.
6. Fitzgibbons P, Cleary K. CAP offers recommendations on selecting surgical specimens for examination. CAP Today 1996;10(7):40.
7. Shen MH, Huang YY, Lee HHC, Huang SH, Chang SC. Is routine pathological evaluation of surgical specimens of hemorrhoidectomy necessary? J Soc Colon Rectal Surgeon (Taiwan) 2012;23:27-31.
8. Christensen A, Solstad K. Routine microscopic examination of excised hemorrhoids. Ugeskrift for Laeger 1983;145(31):2369-70.

9. He X, Huang J, Yao J, Chen Z, Lian L, Li S, Rouniyar S, Chen Y, Wu X, Lan P. Routine histopathologic examination of “benign” anal lesions: Is it necessary? Surgery Today 2015;45(4):416-21.
10. Lohsiriwat V, Vongjirad A, Lohsiriwat D. Value of routine histopathologic examination of three common surgical specimens: Appendix, gallbladder, and hemorrhoid. World Journal of Surgery 2009;33(10):2189-93.
11. Bauer P, Fléjou JF, Etienney I. Prospective single-center observational study of routine histopathologic evaluation of macroscopically normal hemorrhoidectomy and fissurectomy specimens in search of anal intraepithelial neoplasia. Diseases of the Colon & Rectum 2015; 58(7):692-7.
12. Abramowitz L, Godeberge P, Staumont G, Soudan D. Recommandations pour la pratique clinique sur le traitement de la maladie hémorroïdaire. Gynécologie Obstétrique & Fertilité 2001;29(12):942-51.
13. Luca N, Valentina A, Federico S, Renato P. Unexpected anal squamous cells carcinoma after open Hemorrhoidectomy. Case Reports in Surgery 2015; 2015:616274.
14. Nordenvall C, Nyren O, Ye W. Elevated anal squamous cell carcinoma risk associated with benign inflammatory anal lesions. Gut 2006;55(5):703-7.
15. Rivadeneira DE, Steele SR, Ternent C, Chalasani S, Buie WD, Rafferty JL. Practice parameters for the management of hemorrhoids (revised 2010). Diseases of the Colon & Rectum 2011;54(9):1059-64.
16. Wald A, Bharucha AE, Cosman BC, Whitehead WE. ACG clinical guideline: Management of benign anorectal disorders. American Journal of Gastroenterology 2014;109(8):1141-57.
17. Matthyssens L, Ziol M, Barrat C, Champault G. Routine surgical pathology in general surgery. British Journal of Surgery 2006;93(3):362-8.