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Procedure for Prolapse and Hemorrhoids(PPH)
Scott D. Goldstein M.D.
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ContentHemorrhoids and Treatment Options
PPH Overview
How PPH Works
Benefits of PPH
Risks and Complications
Conclusion
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Hemorrhoidal Disease Epidemiology
More than 50%* of the population will develop symptomatic
hemorrhoids in their lifetime.
The incidence increases with age.
Some patients will need surgical treatment.
*Source: www.fascrs.org (The American Society of Colon and Rectal Surgeons)
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Hemorrhoids and theMost Common Treatments
TREATMENT OPTION1st Degree
Bleeding without prolapse Over-the-counter topical medications such as
creams, suppositories, or wipes
Sitz bath
Dietary
SclerotherapyInfrared Coagulation
2nd Degree
Prolapse without spontaneous reduction Sclerotherapy
Infrared Coagulation
Rubber Band Ligation
Procedure for Prolapse and Hemorrhoids (PPH) *
3rd Degree
Prolapse with manual reduction Rubber Band Ligation
Hemorrhoidectomy
Procedure for Prolapse and Hemorrhoids (PPH)
4th Degree
Irreducible Prolapse Hemorrhoidectomy
Procedure for Prolapse and Hemorrhoids (PPH)
Classifications
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Overview of PPHPPH involves the repositioning of the internal and external hemorrhoids
to their anatomical position through the excision of a strip of excess
prolapsed mucosa above the dentate line.
PPH is not a hemorrhoidectomy in principle; it is a hemorrhoidopexy.
However, part of the internal hemorrhoids may be excised along with the
prolapsed rectal mucosa.
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How PPH Works
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Before PPH
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Repositioning
The surgeon will bring up the prolapsed mucosa into its original
position, lifting the hemorrhoidal tissue into place.
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Retracting
The surgeon will utilize the PPH device to retract excess
mucosal tissue.
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Restoring
Once the excess tissue is retracted, the device then removes the excesstissue and reconnects and restores the anal canal wall.
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Reducing
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Benefits of PPHThe key benefits of PPH compared to conventional
hemorrhoidectomy are:
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The PPH Effect
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Less Pain
Source: 1. Roswell M, Bello M, Hemingway DM. Circumferential mucosectomy (stapled hemorrhoidectomy): randomized,controlled trial. The Lancet, Vol. 355, Mar 4, 2000;779-781.
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Quicker Recovery
0
5
10
15
20
25
Days off
Work
PPH Hemorrhoidectomy
Procedure
Source: Stapled vs Excision Hemorrhoidectomy, Long-term Results of a Prospective Randomized Trial, Hetzer N, Demartines N,Handschin AE, 2002, Archives of Surgery.
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PPH Patient Indications andContraindications
Indications:
2nd degree hemorrhoids, after failure of other therapies
3rd and 4th degree hemorrhoids
Rectal mucosal prolapse
Contraindications:
Absolute: abscess, full thickness rectal prolapse
Relative: non-reducible prolapsed hemorrhoids on the perianal skin, acute thrombosed
internal hemorrhoids, previous rectal surgery (because scarring may cause difficulties in
various stages of the procedure)
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PPH Risks and ComplicationsAs with any surgical procedure, there are risks that accompany PPH:
1. If too much muscle tissue is drawn into the device, it can result in damage to the
rectal wall, resulting in inflammation or infection.
2. The internal muscle of the sphincter may be damaged, resulting in short-termdysfunction, such as severe pain or incontinence.
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ConclusionPPH offers less pain and a quicker recovery to patients in
comparison to conventional hemorrhoid techniques
PPH can be performed on patients with 2nd (after failure of
other therapies), 3rd, and 4th degree hemorrhoids