2020年10月26日星期一

hemorrhoids and anal fissures,Stapling prolapse and hemorrhoidal mucosal circular resection (PPH)

    The PPH operation is to insert a special circular stapler into the rectum through the anus, circularly remove the mucosa and submucosa tissue of the intestinal wall at the lower end of the rectum, and perform an anastomosis at the same time, so that the prolapsed anal cushion is lifted up and the normal anal cushion is restored. The anatomical position plays the role of "suspension", and at the same time cuts off the arterial blood branch supplying hemorrhoids, and plays the role of "cut-off", so as to achieve the goal of radical cure. It is suitable for hemorrhoids in stage II, III, and IV or circular mixed hemorrhoids mainly internal hemorrhoids. It can also be used for prerectal bulge and intrarectal prolapse that cause functional constipation at the exit site.

    The main technical advantages of this technique are:

    1. Safety: There is no need to remove the anal cushion, and the normal function of the anus is preserved to the greatest extent to avoid complications such as anal stricture and anal incontinence.

    2. Painless: Pull back the hemorrhoids that have prolapsed from the anus, and cut off the blood vessels that provide blood to the hemorrhoids, without damaging the perianal skin, so there is almost no pain after the operation.

    3. Small trauma and quick recovery: The circular stapling of the mucosa is a non-open wound, with less bleeding, eliminating the trouble of dressing change after surgery, and returning to normal life quickly.

    4. Wide range of diagnosis and treatment: ring hemorrhoids, multivalve hemorrhoids, huge isolated hemorrhoids, internal hemorrhoids, external hemorrhoids, mixed hemorrhoids, ring hemorrhoids, incarcerated hemorrhoids, rectal mucosal prolapse, prolapse, etc.

    The treatment mechanism of PPH is to circularly remove a section of the mucosa above the hemorrhoids, and at the same time, anastomose the rectal mucosa at the far and near ends to lift the prolapsed anal pad tissue. In addition, when the mucosa is removed and anastomosed, part of the blood supply is also blocked. The blood vessels in the anal cushion area that have been overly proliferated and expanded are partially atrophy due to the decrease in blood supply, thereby achieving the purpose of preventing its sagging. The best indications should be three-stage hemorrhoids, circular mixed hemorrhoids, and low rectal mucosal prolapse is also an indication. The traction of the non-invasive forceps should be gentle, the tear of the anal margin is the main cause of postoperative pain; strict preoperative bowel preparation and strict aseptic operation are the key to preventing infection; the purse string suture should be deep and accurate, and the steps should be even And make the purse-string suture on a cross section, you can control the width of the tissue to be removed and the height of the anastomosis according to the size of the hemorrhoids and the degree of prolapse. Double-layer purse-strings should be used if necessary. The two purse-strings should be kept parallel and not spaced apart. If it is too wide, it can be used as the starting and ending points of purse-string suture at the larger points of the hemorrhoids. The starting and ending points tend to cut more tissues, so that the effect of suspending and blocking blood supply will be better; after firing the stapler should be closed for a little longer , To ensure a tight anastomosis and reduce the bleeding of the anastomosis; check the anastomosis carefully, if there is a pulsating bleeding point, make a "8" stitch under the eyes directly until the bleeding is stopped; after placing an exhaust pipe 24h, you can observe whether Bleeding and bleeding can reduce flatulence.

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