by ghchealth on Tue Mar 15, 2005 1:56 pm
This technique is also known as stapled hemorrhoidopexy, stapled hemorrhoidectomy, and circumferential mucosectomy. It was developed in the early 90s to remove the prolapse of hemorrhoidal tissue using a circular stapling device. Hemorrhoids are a common ailment that affects over half of the adult population in America. They are enlarged veins that develop in and around the anal canal when excessive pressure is exerted in the rectal area. The Procedure for Prolapse in Hemorrhoids is a surgical technique that can be used place of traditional hemorrhoid surgery to alleviate hemorrhoids with less pain and recovery time.
Types of Hemorrhoids
Hemorrhoids can occur both inside the anus (internal hemorrhoids) and under the tissue surrounding the anus (external hemorrhoids.) Internal hemorrhoids are usually not painful but they may bleed. It may become a prolapsed hemorrhoid if it protrudes through the rectum and hangs outside of the anus. Prolapsed hemorrhoids may recede back into the rectum on their own. Or they may go back if they are gently pushed. A prolapsed hemorrhoid that cannot be pushed inside may require medical intervention.
What Causes a Prolapsed Hemorrhoid?
Several factors can cause a hemorrhoid to prolapse. Constipation accompanied by prolonged straining and pregnancy, are two of the most common causes of a prolapsed hemorrhoid. Age is another contributing factor. As the muscles and tissues age, the support system weakens and makes it easier for a hemorrhoid to prolapse.
Treatment of Hemorrhoids
Depending upon the type of hemorrhoid that develops, there are different techniques that can be used to alleviate or remove hemorrhoids. Procedures include: Clot Removal, Rubber Band Ligation, Sclerotherapy, Laser Coagulation, Infrared Coagulation, Hemorrhoidectomy, or PPH (Procedure for Prolapse and Hemorrhoids.)
Clot Removal is a minor procedure that can be performed on an outpatient basis. Using a local anesthetic, a doctor can excise the hemorrhoidal clot right in the office.
Rubber Band Ligation: This is the most commonly used procedure in the United States for prolapsed hemorrhoids. It is a relatively simple procedure in which the doctor places a rubber band around the prolapsed hemorrhoid to cut off circulation to the affected area.
Sclerotherapy: Also called injection therapy, sclerotherapy uses a chemical hardening agent to cut off circulation to the hemorrhoid. This procedure is most commonly used on small hemorrhoids.
Laser and Infrared Coagulation: These surgical techniques utilize either a laser or an infrared light to burn off the hemorrhoid.
Hemorrhoidectomy: Hemorrhoid surgery is typically performed only on the most severe hemorrhoids. It is usually recommended for large internal or external hemorrhoids, or for hemorrhoids that present extreme symptoms of pain or itching. During this procedure, the hemorrhoid is surgically removed under either local or general anesthesia.
PPH: The Procedure for Prolapse and Hemorrhoids reduces the prolapse of hemorrhoidal tissue by excising a band of the prolapsed membrane with a stapling device.
The Technique of PPH
In PPH, the prolapsed tissue is pulled into the stapling device and excess tissue is removed while the remaining hemorrhoidal tissue is stapled. The hemorrhoidal tissue is therefore restored back to its original anatomical position.
A device called an anoscope is used to create a purse string suture around the entire circumference of the anus. The suture is then tied externally with a closing knot, and the entire casing of the stapling device is inserted into the anal canal. Moderate traction is kept on the suture, and a simple maneuver is used to draw the prolapsed hemorrhoidal tissue into the casing of the stapling device. The device is then used to fire a staple into the hemorrhoid. A double row of titanium staples is released when the stapler is fired and a circular knife excises the excess tissue. If there is bleeding along the suture line, additional absorbable sutures may be placed. Compared to conventional hemorrhoid surgery, patients generally report less pain and a shorter recovery period with PPH.
The Risks of PPH
As with any surgical procedure, PPH can cause both short term and long term problems. Damage to the rectal wall can occur if too much muscle is drawn into the stapling device. It is also possible for the internal muscles of the anal canal to stretch, resulting in bowel dysfunction. Cases of pelvic sepsis have also been reported following this procedure. Persistent pain and bowel urgency have also been reported following stapled hemorrhoidectomy.
