PPH (procedure for prolapse and hemorrhoids) is a method of treating prolapse and hemorrhoids. In 1997, Pescatori reported the use of transanal stapling for rectal mucosal resection for the treatment of rectal mucosal prolapse. In 1998, Italian scholar Longo used this technique to treat prolapse of hemorrhoids and described the mechanism of rectal mucosal circular resection for the treatment of prolapsed hemorrhoids. Later, it was gradually promoted and applied clinically in China. This surgical method has the advantages of not destroying the anal cushion, not damaging the perianal skin, light postoperative anal pain, quick recovery, and satisfactory short-term efficacy.
1. Surgery steps:
1. Use three non-traumatic forceps to fix and spread the hemorrhoids at the three points where the prolapse of the hemorrhoids is less and the mucosal eversion is slight, so that the circular anal dilator (CAD33) can be introduced more easily. The imported CAD33 can partially restore the prolapse of hemorrhoids or anal canal mucosa. After removing the inner plug, the prolapsed mucosa fell into the CAD33 sleeve. Since CAD33 is transparent, we can observe the dentate line through it.
2. Introduce the anal mirror suture ligator (PAS33) through CAD33. This device can cover the prolapsed mucosa in the range of 270 degrees around the rectal wall, so that only the part of the prolapsed mucosa exposed through the opening of PSA33 can be sutured. The distance of the suture must be more than 3-4 cm from the tooth line. Of course, the specific location should be adjusted accordingly according to the degree of prolapse. By rotating PSA33, the purse string suture around the entire anal canal can be completed.
3. Unscrew the round hemorrhoid stapler (HCS33) to the maximum position. Import HCS33# to make its head go deep to the upper end of the purse string, and then tie the suture. With the help of a threader (ST100), pull the end of the suture out of the side hole of the HCS33. Knot the suture dragged outside the stapler or fix it with a clip applier. The head of the HCS33 is completely guided into the anal canal. During this process, it is recommended to partially tighten the stapler.
4. Pull the purse-string suture moderately and place the prolapsed mucosal layer into the cavity of the head of HCS33. Close the stapler, fire and excise the prolapsed mucosa in the cavity. Keep HCS33 closed for at least 30 seconds after firing to help stop bleeding. Gently unscrew the HCS33 and remove it from the anal canal.
5. Check the anastomosis through PSA33. If necessary, several stitches can be added.
3. PPH surgery is suitable for severe (stage Ⅲ to Ⅳ) circular internal hemorrhoids and mixed hemorrhoids dominated by circular internal hemorrhoids, rectal protrusion, and incomplete rectal prolapse.
4. Compared with traditional surgery, PPH surgery has the following advantages: simple operation, short time, less bleeding; postoperative fine control ability is not affected; postoperative pain or painless, fewer complications, and low recurrence rate; postoperative The patient can quickly return to normal life.