PPH Surgery

PPH, a minimally invasive surgical technique, was developed in the early 90's in the United States. PPH is performed on an outpatient basis and is also known as Stapled Hemorrhoidectomy, and Circumferential Mucosectomy.

PPH is typically used for treating advanced hemorrhoids with the benefits of less pain and a faster recovery time than traditional removal methods such as hemorrhoidectomy (removal of affected tissue with a scalpel) and Rubber Band Ligation (cutting off blood supply to the affected area with tiny rubber bands).

The Procedure for Prolapse and Hemorrhoids uses a circular-stapling device that removes a donut-shaped section of anal tissue and essentially "lifts up" the hemorrhoidal tissue and places it back in the original, normal anatomical position. The accompanying reduction of blood flow to the hemorrhoids causes them to shrink within four to six weeks after treatment.

This procedure is done in an operating room by a general or colorectal surgeon and is usually performed in 30 to 45 minutes. Patients who undergo PPH return to normal activity in a significantly shorter time than patients undergoing traditional methods.

Here is a brief video illustrating PPH.

Clinical trial results comparing PPH to conventional hemorrhoid surgery have shown:

- Patients experienced less pain and required less postoperative pain medication as compared to conventional techniques.
- Patients experienced less post-procedure bleeding, itching, incontinence, and constipation compared to hemorrhoidectomy.

- Patients experienced fewer overall complications compared to conventional techniques.
- Average inpatient stay was lower compared to patients treated with conventional techniques.
- Patients experienced a quicker return to normal activities compared to those treated with conventional techniques.

Although rare, there are risks that accompany PPH:

- If too much muscle tissue is drawn into the device, it can result in damage to the rectal wall.

- The internal muscles of the sphincter may stretch, resulting in short-term or long-term dysfunction.

- As with other surgical treatments for hemorrhoids, cases of pelvic infection have been reported following stapled hemorrhoidectomy.

- PPH may be unsuccessful in patients with large confluent hemorrhoids. Gaining access to the anal canal can be difficult and the tissue may by too bulky to be incorporated into the housing of the stapling device.

- Persistent pain and fecal urgency after stapled hemorrhoidectomy, although rare, has been reported.

Before choosing a surgical procedure for the treatment of hemorrhoids, there are questions you should ask your surgeon:

- What types of hemorrhoid procedures have they performed?
- How many of each procedure have they performed?
- Why are they recommending one particular hemorrhoid procedure over another?
- How long will the procedure take?
- Will this procedure require a hospital stay and, if so, for how long?
- How long will the recovery process take?
- How soon can "normal" diet and activity be resumed?
- Will having the procedure require any long-term changes in work, diet, and activity?
- What are the potential risks and complications of conventional hemorrhoidectomy?
- What are the potential risks and complications of PPH hemorrhoid surgery?

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