CC BY-NC-ND 4.0 · Journal of Coloproctology 2022; 42(02): 140-145
DOI: 10.1055/s-0041-1742257
Original Article

A Morphometric Analysis of Pathological Alterations in Hemorrhoidal Disease Versus Normal Controls: A Controlled Trial

1   Department of Surgery, School of Nutrition and Translation Research in Metabolism (NUTRIM), Maastricht University, Maastricht, The Netherlands
,
2   Department of Surgery, Diakonessenhuis Medical Centre, Utrecht, The Netherlands
,
3   Department of Anatomy and Embryology, Maastricht University, Maastricht, The Netherlands
,
4   Department of Pathology, Maastricht University Medical Centre and School for Cardiovascular Diseases (CARIM), Maastricht University, Maastricht, The Netherlands
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5   Department of Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
,
3   Department of Anatomy and Embryology, Maastricht University, Maastricht, The Netherlands
,
6   Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre, Maastricht, The Netherlands
,
1   Department of Surgery, School of Nutrition and Translation Research in Metabolism (NUTRIM), Maastricht University, Maastricht, The Netherlands
5   Department of Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
7   Department of Surgery, School for Oncology and Developmental Biology (GROW), Maastricht University, Maastricht, The Netherlands
› Author Affiliations
Funding No funding was received for conducting the present study.

Abstract

Objective Until today, the true pathophysiology of hemorrhoidal disease (HD) has not yet been unraveled. More and more evidence guides us towards the hypothesis that reduced connective tissue stability is associated with a higher incidence of hemorrhoids. The present study aimed to compare the quantity and quality of collagen, and vessel morphometrics, in patients with symptomatic HD compared with normal controls.

Methods Twenty-two samples of grade III and grade IV HD tissue from patients undergoing a hemorrhoidectomy between January 2004 and June 2015 were included in the study group. Samples of 15 individuals without symptomatic HD who donated their body to science and died a natural death served as controls. The quantity and quality of anal collagen, and anal vessel morphometrics were objectified. The quality of collagen was subdivided in young (immature) and old (mature) collagen.

Results Patients with HD had an increased percentage of total anal collagen (62.1 ± 13.8 versus 18.7 ± 14.5%; p = 0.0001), a decreased percentage of young collagen (0.00009 ± 0.00008 versus 0.0008 ± 0.0008%; p = 0.001), and a smaller surface area of the anal vessels (795.1 ± 1215.9 micrometre2 versus 1219.0 ± 1976.1; p = 0.003) compared with controls. The percentage of old collagen did not differ between the control and study groups (0.588 ± 0.286% versus 0.389 ± 0.242%; p = 0.06).

Conclusion The outcomes of the present study suggest that alterations in anal collagen composition may play a role in the formation of hemorrhoids.

Ethics Approval

Ethical clearance for the present study was obtained from the Maastricht University Medical Centre ethical review board (file number 2017-0065).


Consent to Participate

Informed consent was obtained from all individual participants included in the present study.


Consent for Publication

Not applicable.


Availability of Data and Material

Available on special request.


Code Availability

Not applicable.


Contributions of the Authors

All authors whose names appear on the submission (1) made substantial contributions to the conception or design of the work; or to the acquisition, analysis, or interpretation of data; (2) drafted the work or revised it critically for important intellectual content; (3) approved the version to be published; and (4) agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.




Publication History

Received: 10 August 2021

Accepted: 25 October 2021

Article published online:
02 February 2022

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