Surgical treatment for hemorrhoids - Stapled hemorrhoidopexy (PPH)

Stapled Hemorrhoidopexy (PPH)

Stapled Hemorrhoidopexy procedure for treatment of internal hemorrhoids

Stapled Hemorrhoidopexy (also called PPH – Procedure for Prolapse and Hemorrhoid) is a newer method for treatment of internal hemorrhoids. It’s usually indicated for the treatment of prolapsed internal hemorrhoids (third or fourth grade). This alternative method has been first described by Italian surgeons. It has been popularized by the Italian surgeon Antonio Longo and that’s why the procedure is also known as Longo’s method in some countries. The operation itself is performed under anesthesia (local, regional or general).

The stapled hemorrhoidopexy involves a special stapler device. With its help, the surgeon can circumferentially excise the redundant mucosa and submucosa. The stapler will also lift the prolapsed hemorrhoids and fixate them back to their normal position. The staple line will divide the arterial inflow in the submucosal space, devascularizing the hemorrhoids. The procedure is more similar to Rubber band ligation than to excisional hemorrhoidectomy since the hemorrhoidal tissue isn’t completely removed. It also incorporates elements of hemorrhoidal devascularization (just like DG-HAL). During the operation, the stapler is pushed above the internal hemorrhoids. The stapler line should lie approx. 2 cm above the top of the hemorrhoids. Thus, one of the benefits of this procedure is that the staple line is above the pectinate line and it should cause less pain (compared to excisional hemorrhoidectomy).

Hemorrhoidopexy stapler by Covidien
Hemorrhoidopexy stapler by Covidien. Image is courtesy to Covidien.

Stapled Hemorrhoidopexy (PPH) recovery

Recent studies have shown that the postoperative pain is significantly lower than after excisional hemorrhoidectomy. The patient could return to normal activities in about 7-10 days. However, there are several complications that may arise, mainly – anal stenosis, rectal perforation, pelvic sepsis, sphincter injury and fecal incontinence. None of these is really common in the hands of a good surgeon. More long-term trials are needed to evaluate the effectivity of PPH in patients suffering from high-grade internal hemorrhoids. The stapled hemorrhoidopexy is more suitable for patients with severe prolapse. The procedure is costly since it involves a stapler device.

For a smoother postoperative course, physicians will prescribe analgesics and might inject an anesthetic agent into the internal sphincter. You should stick to a high-fiber diet and drink plenty of fluids. Supplements, such as psyllium, can be useful in moderate amounts. You should be careful to avoid constipation and diarrhea. Normal activities could be resumed in about a week. Delayed bleeding could be presented, but severe bleeding should be discussed with the operating surgeon.

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