PPH is the abbreviation of Procedure for prolapse and hemorrhoids in English, which translates directly from the literal: a method of treating rectal mucosal prolapse and hemorrhoids. The basic principle is to use a special stapler to cut the hemorrhoid mucosa for a week to lift the prolapsed anal cushion, so that the hemorrhoids no longer prolapse; at the same time, the hemorrhoidal artery supplying the hemorrhoids is cut off, so that the hemorrhoid congestion is significantly reduced.
PPH is not suitable for all hemorrhoids. Its surgical indications are: mainly prolapsed internal hemorrhoids of degree III and IV, as well as patients with partial rectal mucosal prolapse.
The advantages of PPH: less pain; no anal deformation; short hospital stay.
Disadvantages of PPH: The long-term recurrence rate is high, and serious complications may occur. The complications of PPH surgery that have been reported include: lower abdominal pain or bradycardia or hypotension when the stapler is activated during the operation, rectal bleeding after surgery, rectal stenosis, persistent postoperative pain, urgency, and short anal discharge Gas incontinence and stool contamination, submucosal infections of the rectal anastomosis, rectovaginal fistula, and even life-threatening pelvic infections. With the promotion of PPH application, it has been applied in China for 10 years. Now regarding the long-term follow-up of PPH, the long-term effect is not satisfactory, mainly due to the problem of recurrence. The recurrence rate is increasing as the postoperative time increases.
Problems and prospects of PPH surgery: To analyze the current status of PPH surgery, the following issues should be paid attention to: (1) PPH indications are narrow. It is used for severe annular prolapsed internal hemorrhoids, and other diseases of the colorectal should be excluded. The Provisional Regulations of the Anorectal Surgery Group of the Chinese Medical Association Association of Anorectal Surgery for the treatment of hemorrhoids with PPH: The indications of PPH are internal hemorrhoids of degree III and IV with annular 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 many complications in the application process, such as bleeding, pain, urinary retention, infection, and rectovaginal leakage. In addition, hemorrhagic shock caused by severe bleeding has also been reported. Although serious complications are individual phenomena, they should arouse sufficient attention. (3) High medical expenses. Foreign studies have shown that due to the recurrence of hemorrhoids and hemorrhoid symptoms after PPH, the reoperation rate is higher than that of the traditional operation, which increases the medical cost, and the medical cost of the PPH operation itself is higher than that of the traditional operation. (4) The long-term effect of PPH operation needs to be further confirmed. Longo believes that the advantages of PPH are: it does not damage the normal structure of the anus, the patient suffers less pain, and the wound recovery only takes 3 to 4 days after the operation. Recent studies by Greco and Hzboubi have shown that due to chronic inflammation and fibrosis, the anal cushion has lost its function. Even if the anal cushion is moved up through PPH, it also loses its anal cushion function and anal bowel control ability. In short, short-term and long-term studies on PPH postoperative complications show that inappropriate use of PPH will lead to serious postoperative complications and a higher recurrence rate; the theoretical basis of PPH surgery needs to be verified through long-term clinical observations Therefore, the advantages of PPH surgery have yet to be judged by long-term follow-up and large-sample multi-center randomized controlled studies.
From our clinical practice: 1 PPH indications should be strictly restricted. 2 The surgeon must have mature experience in the use of ordinary staplers. 3 Do not blindly expand the promotion of PPH advantages and avoid discussing its shortcomings and complications. Therefore, traditional hemorrhoidectomy is still the main way to treat hemorrhoids.