SRS154 - Routine histology after haemorrhoidectomy: uncovering the hidden risk of malignancy?

Abstract Introduction Histological analysis of haemorrhoidectomy specimens is frequently omitted, based on the assumption that clinical diagnosis is sufficient to exclude malignancy. However, this practice may overlook rare but clinically significant pathology, including malignancy. We aimed to evaluate the current rate of histology submission and assess the true incidence of unexpected findings, including cancer. Methods A retrospective review was conducted of all haemorrhoidectomy procedures at a single UK institution from January 2017 to April 2025. Data collected included patient age, gender, histology submission status, and final pathology. Statistical analysis was performed using chi-square and Mann-Whitney U tests to assess whether demographic factors influenced histology submission. Local ethical committee approval was obtained. Results Of 548 haemorrhoidectomy procedures, only 190 specimens (34.7%) were submitted for histological examination. Among these:177 (93.2%) confirmed haemorrhoids13 (6.8%) revealed unexpected benign pathology, including mucosal prolapse and inflammatory polyps2 (1.05%) were malignant (anorectal adenocarcinoma and squamous carcinoma) There were no significant differences in age (P = 0.17) or gender (P = 0.53) between patients with and without histology submission. Conclusions Among specimens examined, 1 in 14 harboured unexpected pathology and 1 in 95 revealed malignancy. Yet two-thirds of specimens were not sent for analysis. These findings reveal a critical blind spot in routine practice. We advocate for the standardisation of histological assessment after haemorrhoidectomy to reduce missed malignancies and uphold patient safety.