Introduction to PPH surgery
Principle of operation
PPH is called circumcision and nailing of hemorrhoids. Its principle is a new operation under the guidance of the modern concept of hemorrhoids, that is, the theory of lower anal cushion. The anal cushion is moved upward, and the end branches of the arteries and veins under the rectum are removed and ligated at the same time, so that the blood supply of the hemorrhoids is reduced and the hemorrhoids gradually atrophy.
The disposable anal hemorrhoids stapler is suitable for the repair of prolapse of the rectal mucosa in the anal canal or hemorrhoid tissue nailing, as well as prolapsed hemorrhoids, that is, hemorrhoids in stage II, III, and IV or mixed hemorrhoids with internal hemorrhoids, especially Hemorrhoids in a ring. In other words, the hemorrhoids that fall out more and larger each time you defecate are more suitable for PPH surgery.
Epidermal external hemorrhoids and mixed hemorrhoids dominated by external hemorrhoids are not indications.
Advantages and disadvantages of PPH
The advantages are that there is no pain in the anus, less bleeding, significantly shortened operation time and recovery time (usually 3 to 7 days can go to work normally), satisfactory results and fewer complications; these are unmatched by traditional hemorrhoid surgery. Because it does not remove the anal cushion, the ability to finely control the stool will not be affected; the anal skin and hemorrhoids will not be removed, the anal canal and anal skin have no wounds, there is no need to change the dressing after the operation, and there is no traditional external stripping and internal ligation. Common complications such as anal pain, edema, and anal stenosis can quickly return to normal life after surgery.
The disadvantage is that the hemorrhoids stapler is disposable and expensive. The short-term effect of this operation in the treatment of internal hemorrhoids prolapse and hemorrhoids caused by hemorrhoids is relatively reliable, but the long-term effect remains to be further observed. The preliminary results have a recurrence rate of 3% to 4%.
Contraindications It is not recommended for pregnant women, children, intractable constipation, pelvic tumors, portal hypertension, Bu-Ca syndrome or those who cannot tolerate surgery.
Operating mechanism and characteristics The disposable anal hemorrhoid stapler is a PPH surgical instrument. The mechanism of the PPH surgical method is to circularly remove the mucosa and submucosa of the intestinal wall at the lower end of the rectum near the upper edge of the prolapsed internal hemorrhoids, and anastomose the distal and proximal mucosa at the same time to make the prolapsed internal hemorrhoids and mucosa Being suspended and pulled upwards, no longer prolapse. At the same time, the blood supply of hemorrhoids from the superior rectal artery in the submucosal layer is cut off, and the blood supply of hemorrhoids after operation is reduced and tends to become smaller. Therefore, the exact name of the operation is "circular resection of the prolapse and hemorrhoids and anal cushion suspension."
The structural feature is that the nail seat assembly and the stapler body are designed to be separated from each other, so that the purse can be sewn, and the two can be butted during kiss cutting, which is convenient for operation.
The long-term prognosis of PPH is better than traditional hemorrhoidectomy, and the recurrence rate is lower. It has been widely accepted and carried out by general surgery in many hospitals. It has many advantages over the former, such as beautiful appearance and less bleeding.
1. Urinary retention: The incidence is about 40% to 80%, more men than women, which may be related to spinal anesthesia and postoperative anal pain and reflex stimulation of the urethral sphincter.
2. Anal pain: There is no wound on the perianal skin from the pph operation, and there should be no pain in the anal area after the operation. However, due to the expansion of the anus and clamp the perianal skin during the operation, it often causes tearing and damage to the anal skin. Most patients still have pain in the anus after surgery, but the pain is less than the traditional external stripping and internal ligation surgery. Generally, the pain is obvious on the night of the operation and can be relieved the next day. Except for a few patients who need pain medication, they can generally be tolerated ；
3. Lower abdominal pain: Approximately 20% of patients complained of lower abdominal pain on the day after the operation. Some patients have diarrhea or vomiting, which does not require special treatment and can relieve itself the next day. The mechanism is not clear, and it may be related to the intestinal anastomosis. The pulling reflection of Tao is related;
4. Bleeding: It is a common complication after surgery, mainly located at the anastomotic site. Most patients have less bleeding and do not need special treatment. However, it has been reported that some patients have stroke-associated bleeding at the anastomotic site, and even cause hemorrhagic shock after the operation. The main prevention method is to carefully check whether there is bleeding at the anastomotic site after the anastomosis. In the author's group of surgical patients, about 30% After anastomosis, pulsatile bleeding can be seen at the anastomotic site, most of which are located on the right front, followed by the right posterior and left center, which are the same as the three female hemorrhoids. In addition, the amount and severity of anastomotic bleeding The distance between the anastomosis and the dentate line is related, and the higher the distance, the less bleeding; on the contrary, if the anastomosis is closer to the dentate line, that is, when the anastomosis is located in the middle of the internal hemorrhoids (part of the internal hemorrhoids are removed), the bleeding will be more;
5. Infection: The incidence is low, but there are reports of death due to pelvic infection after surgery;
6. Recto-vaginal fistula: It has been reported in the literature that it is mainly caused by excessively deep purse string suture on the anterior wall, which damages the rectum-vaginal wall and is accompanied by infection.