A PPH hemorrhoidectomy, also known as a Procedure for Prolapse and Hemorrhoids or stapled hemorrhoidectomy, treats internal hemorrhoids, particularly those that have prolapsed, meaning they have slipped out of their normal position.
Understanding the Procedure
The PPH technique uses a circular stapling instrument inserted through the anus into the rectum. This device removes a circumferential section of the internal rectal lining above the hemorrhoids. This pulls the prolapsing blood vessels of the hemorrhoids back into their normal anatomical position within the anal canal.
The procedure also interrupts the blood supply to the hemorrhoids, causing them to shrink. Unlike traditional hemorrhoidectomy, PPH creates a wound inside the rectum, which is less sensitive to pain than the outer anal area. This method focuses on repositioning the prolapsed tissue and reducing blood flow, rather than directly cutting away the hemorrhoidal cushions.
When PPH is Considered
PPH hemorrhoidectomy is considered for severe internal hemorrhoids, specifically Grade III or Grade IV prolapse. Grade III hemorrhoids prolapse during bowel movements but can be manually pushed back inside, while Grade IV hemorrhoids remain prolapsed and cannot be reinserted. This procedure is recommended when non-surgical treatments, such as dietary modifications, rubber-band ligation, sclerotherapy, or infrared coagulation, have not been successful.
The rationale for choosing PPH centers on its effectiveness in managing significant prolapse and addressing symptoms like bleeding and discomfort. It is primarily for internal hemorrhoids and is not used for external hemorrhoids or anal fissures. For patients with a large external component, traditional excision might be a more effective option.
Recovery and Post-Procedure Care
Following a PPH procedure, patients can expect a recovery period with less pain compared to traditional hemorrhoidectomy. Discomfort within the back passage is common during the first few days, and pain-relieving medication is prescribed to manage this. Some patients may experience an urgent need to open their bowels even when there is no stool.
Bowel movements may involve some bleeding initially, which subsides within a few days. Dietary recommendations include increasing fluid and fiber intake to promote softer stools and reduce straining. Most patients can resume normal activities within a few days and are fit for work quickly. Staples may be passed during defecation, which is a normal part of the healing process.
Potential Outcomes
PPH hemorrhoidectomy is effective in resolving symptoms and improving the quality of life for patients with prolapsed internal hemorrhoids. It can reduce postoperative pain, bleeding, and improve anal comfort compared to conventional hemorrhoidectomy. The procedure aims to restore the anorectal tissue to its normal anatomical position and restore anal bowel function.
While successful, there is a possibility of recurrence, with studies indicating that approximately 5-8% of patients may experience further hemorrhoids. Less common long-term issues include persistent urgent need to go to the toilet, with some leakage, or narrowing of the back passage. Overall, patients can anticipate a good outcome with reduced symptoms and a quick return to daily activities.