Prolapse and hemorrhoids (procedure for prolapse and hemorrhoids, PPH) is currently the most popular and safest high-end hemorrhoid surgery, but it is not a panacea. Whether PPh can be performed must be comprehensively diagnosed. In June 1998, Professor Liu Zhixiang from the Fourth Hospital of Xingtai City completed the first PPH operation in the province. When the blood vessels in the submucosa are congested due to dysregulation or the supporting tissues of the anal cushion Parks ligament and Treitzs muscle are broken, the anal cushion moves down and the anal cushion is called hemorrhoids. PPH is a circular removal of the rectal mucosa above the dentate line to move the anal cushion up, block the blood supply of hemorrhoids, control bleeding symptoms and shrink the remaining part of hemorrhoids, so as to achieve the purpose of curing hemorrhoids.
Common complications after PPH
Common complications after PPH are: severe pain, bleeding, thrombosis, urinary retention, anastomotic dehiscence, and anal fissure. Five domestic hospitals, including Xingtai Fourth Hospital and Tianjin Binjiang Hospital, conducted studies on 251 cases of grade III to IV hemorrhoids and showed that the complications of PPh were: urinary retention 36.2%, anal pain, blood in the stool, lower limb discomfort, and difficulty defecation. In one case, a pelvic infection occurred, and no anastomotic leakage was found during the operation. It may be caused by inflammation or infection of the original rectum, and the infection of the rectal mucosa was spread to the pelvic cavity after the staples were tightly closed. There is also a case of severe vagus nerve reflex, the common clinical manifestations are intraoperative tightening of the purse string, stretching of the mucosa, tightening of the stapler, and cramping pain, irritability, nausea, and vomiting in the lower abdomen during firing. A small number of patients have some serious complications: postoperative anastomotic bleeding; operation failure; paraanal infection. It can be seen from the above literature that PPH still has many complications in the application process, such as blood in the stool, anal pain, urinary retention, anal discomfort, difficulty defecation, bleeding, thrombosis, anastomotic opening, anal fissure, lower limb discomfort, Difficulty defecation, postoperative anastomotic bleeding, paraanal infection, pelvic infection.
Comparison of short-term complications after PPH and traditional methods
A comparison of 50 cases of PPH and Milligan-Morgan (MMH) surgery showed that: PPH had less pain (average analgesics 2.60vs15.9) and faster recovery to normal activities (8.04vs16.9d). Mehigan et al. reported that 85% of patients with PPH treatment were satisfied with postoperative symptom control, while MMH hemorrhoidectomy accounted for 75%. Since the initiation of PPH surgery, in the comparative study of PPH and MMH surgery with a large number of domestic cases, the operation time, pain index, frequency of injection analgesia, hospital stay, recovery time and postoperative complications have been compared In terms of rate, PPH is better than MMH group. Schmidt et al. reported that comparing 80 cases of similar patients treated with PPH and traditional surgery, the complication rate of PPH was 4%, while that of traditional surgery was 11%. Cheethamb reported that there was a 31% incidence of tense and severe after PPH. He believed that it was caused by anastomotic ring stimulation of sphincter spasm. HO et al.  randomly divided 119 cases of prolapsed hemorrhoids into the traditional open electrosurgical resection and electrocoagulation (diathermy, DT) group of 62 cases and the PPH group of 57 cases. Preoperative incontinence score, anorectal pressure measurement, and rectal cavity Ultrasound. After 3 months of re-examination, the pain index, the demand for analgesics, the quality of life, and the cost of treatment were evaluated again. The results showed that the operation time of DT hemorrhoidectomy was shorter than that of the stapler, and the hospital stay was the same in the two groups. The pain index of DT during defecation within 2 weeks after surgery was higher than that of the PPH group, and the demand for analgesics was more than that of the PPH group within 6 weeks. That is, the short-term efficacy PPH group has advantages, but the long-term effects and long-term complications cannot be evaluated.
Comparison of long-term complications after PPH and traditional hemorrhoidectomy
Pavlidis et al. randomly divided 80 patients into two groups and followed up for more than 2 years. 95% of the patients in the PPH group were satisfied with postoperative symptom control, while the satisfaction rate of the MMH hemorrhoidectomy group was 89%. Ebert et al.  followed 214 patients after MMH for 54 months, and 68% of the patients had no obvious symptoms. After some optimistic reports about PPH surgery[13,14], there have been reports that are not optimistic in recent years. 38% of patients have recto-vaginal fistulas after PPH surgery, and fatal pelvic infections have not been obtained in 19 months. Significant improvement. A retrospective investigation by Pescatori and Aigner  on the application of PPH over the past 10 years showed that the incidence of rectal stenosis and severe pelvic infection requiring a diversion stoma is more common than traditional hemorrhoidectomy.However, the serious complications caused by traditional hemorrhoidectomy do not require a diversion stoma . Because of postoperative complications such as chronic anal pain, bleeding, and hemorrhoid prolapse, the probability of reoperation one year after PPH is reported to be up to 11%, and there is a higher recurrence rate for the treatment of grade IV hemorrhoids. Rectal pain is usually intractable dull pain, accompanied by urinary urgency, which may be due to fibrosis around the anastomosis affecting the autonomic nerve endings of the rectal ampulla. Recently, Jayaraman and Colquhoun  were in a meta-analysis It is certain that PPH will bring a higher reoperation rate (OR=2.3) compared with traditional hemorrhoidectomy, and its only advantage is to reduce pain; therefore, traditional hemorrhoidectomy is still the choice of treatment for hemorrhoids. In a large-scale retrospective survey, the incidence of life-threatening complications after PPH can be as high as 1 in 1,200. Usually, sepsis caused by PPH is rare, however, some scholars have reported complications such as abscesses, fistulas, and retroperitoneal sepsis. It was confirmed by intracavitary ultrasound  that the damage of PPH to the anal sphincter is similar to that of traditional hemorrhoidectomy. Studies have shown that 23% of patients after PPH have urinary urgency and increased defecation frequency, and 5% of patients have difficulty in defecation and feeling of unclean stool. Cheetham  has similar reports. In 2004, Nisar et al.  emphasized the potential destructive complications of PPH in a meta-analysis, and considered that traditional hemorrhoidectomy is the gold standard for hemorrhoid treatment.
Problems and prospects of PPH
Analyzing the current status of PPH treatment, President Liu Zhixiang reminded experts in anorectal surgery to pay attention to the following issues: (1) PPH indications are narrow. It is used for severe annular prolapsed internal hemorrhoids, and other diseases of the colorectal should be excluded. Liu Zhixiang pointed out that the indications of PPH are internal hemorrhoids of degree III and IV with circular prolapse, and internal hemorrhoids of degree II with repeated bleeding. (2) Prevention and treatment of serious complications. The operation of stapler hemorrhoid fixation is simple and easy to master, but there are still more complications if you do not pay attention to details during the operation, such as bleeding, pain, urinary retention, infection, and recto-vaginal leakage. In addition, severe bleeding caused hemorrhagic shock. (3) PPH surgery has a good long-term effect. The advantage of PPH is that it does not damage the normal structure of the anus, the patient suffers less pain, and it only takes 3 to 4 days for the wound to recover after the operation. In short, the short-term and long-term studies on the postoperative complications of PPH show that inappropriate application of PPH will lead to serious postoperative complications and a higher recurrence rate.