Classifying the Degree of Hemorrhoids Based on the Form of Macroscopic Piles' and Locations of the Epithelial Zone around the Anal Canal

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  • 肛門管内外の解剖学的区画と病態に基づく痔核程度分類

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Abstract

In Japan, Goligher's internal hemorrhoid classification has been generally used for diagnosing the 2nd or 3rd degree depending on how patients reposition prolapsed piles, naturally or manually. This study examined the relation between anal prolapse and the form and location of objective piles, consisting of three compartments, first (above the dentate line), second (below the dentate line to the intersphincteric groove) and third (outside the anus) compartments.<BR>The patho-morphological hemorrhoid classification (“P-c”) is based on lesions over compartment number, diagnosing small piles at the first compartment as the 1st degree, moderate and large piles at the first compartment as the 2nd degree, and extended piles at the second and third compartments as the 3rd and 4th degrees, depending on objective findings. Comparing the relation between patho-morphological classification (P-c) and Goligher's classification (G-c), some cases are diagnosed as the same, but others are not. For example, a case classified as the 2nd degree in the P-classification is classified as the 3rd degree in the G-classification and vice versa.<BR>I report that the clinical significance is how to choose the method of hemorrhoids operation, excisional surgery or sclerotherapy, etc., due to the objective criteria and more correct assessment of those operations' outcome.

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