Abstract

Aim: Hemorrhoidal disease is a common anorectal condition frequently treated with surgical excision in advanced stages. Although the diagnosis is usually clinical, histopathological examination of excised tissue may reveal unexpected benign or premalignant lesions. To evaluate the histopathological spectrum of hemorrhoidectomy specimens and determine the frequency of incidental findings other than hemorrhoidal pathology.
Materials and Methods: This retrospective study analyzed 828 patients who underwent conventional hemorrhoidectomy (Milligan-Morgan or Ferguson technique) between January 2012 and April 2022 at a tertiary care training and research hospital. Selection criteria were inclusion of patients over 16-year-old and submission of surgical specimens for histopathological evaluation. The application of additional anorectal procedures was excluded. Demographic, surgical, and pathological data were collected. Statistical analysis included descriptive measures and normality testing using the Kolmogorov–Smirnov test.
Results: The median age of patients was 33 years (range: 17–80), and 67.1% were male. The Milligan-Morgan technique was used in 67.9% of cases, while the Ferguson method was used in 32.1%. Histopathological examination revealed that 97.8% of specimens were consistent with venous ectasia, characteristic of hemorrhoidal disease. In 2.2% of cases, non-hemorrhoidal lesions were identified: fibroepithelial polyps (1.4%), skin tags (0.4%), anal polyps (0.2%), and one case (0.1%) of anal intraepithelial neoplasia grade 2 (AIN 2), a premalignant lesion.
Conclusion: While the vast majority of hemorrhoidectomy specimens confirmed the clinical diagnosis, a small proportion revealed incidental benign or premalignant lesions. These findings underscore the importance of routine histopathological evaluation, especially in high-risk patients, to avoid missing significant pathology that may impact clinical management.

Key words: Hemorrhoidal disease, hemorrhoidectomy, histopathology, venous ectasia, fibroepithelial polyp, anal intraepithelial neoplasia, routine pathology, anorectal surgery