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PPH stapled hemorrhoidopexy

Modern and very efficient method, suitable for treatment of the advanced stage of hemorrhoidal disease. It is a procedure that removes as much hemorrhoidal tissue as it is possible, after which the residue is returned into normal anatomic position. Compared to complete removal of hemorrhoids, this method is generally less painful and related to quicker recovery. Relapse is very rare if the procedure is done technically perfectly.

Description of the procedure

Method in which for fixing the prolapsed hemorrhoids and rectal mucosa, as well as for removal of ‘extra’ tissue, a specially designed circular stapler (‘stapler’ for intestine) is used. This method was very popular 10-15 years ago, especially in Italy and USA. Its advantage is speed – the procedure itself takes about 30-45 minutes. Furthermore, the problem is removed efficiently and permanently, and it is less painful than classical methods. Disadvantages are ‘various': in normal postoperative course, patients often complain about constant ‘fake calls’ to defecate (rectal tenesmus), 10-14 days after the procedure; after that period this problem gradually withdraws.

Candidates

Patients with grade III and IV of hemorrhoidal disease, and those with rectal mucosa prolapse. Likewise, it is performed after several unsuccessful ambulatory interventions in patients with grade II of the disease.
Limitations: Active inflammatory diseases of the anal region, narrowing of the anal canal, prolapse of rectum in full-thickness

Preparation

Act according to the instructions given by the anesthesiologist during the preoperative examination. Day before the procedure, have a light lunch (soup, cooked meat/fish, vegetables or pasta, rice…). About 2 hours after that start the preparation with MoviPrep – follow the instructions. First ‘dose’, i.e. 1l of the preparation dissolved in water – must be drunk right away. Second ‘dose’ should be taken in the evening (perhaps early in the morning is possible, if you are a ‘morning type’, or the procedure is scheduled after 11am).
On the day of surgery, in the morning, approx. 2 hours before the procedure, drink 0,5l of Donat Mg. Simultaneously with preparation, i.e. ingestion of MoviPrep, drink enough fluid due to loss of liquid via defecation; the best is water, tea, mild juice. Come for the procedure on an empty stomach.

Course of the procedure

The procedure removes as much hemorrhoidal tissue as it is possible, after which the residue is returned into normal anatomic position. The procedure is done in a so-called ‘safe zone’ of the end of large intestine; a circular excision of the mucosa is done, bloodstream is interrupted and mucosa lift is performed.

Recovery

Postoperatively, after discharge, patient is supplied with analgesics for the next 2 days; after that, analgesics, as well as other sorts of individual therapy, are prescribed by his family doctor. Patients prone to thromboprophylaxis (which is determined on the preoperative anesthesiologist’s examination) are daily ensured adequate therapy by the personnel of Polyclinic Lege Artis in their own home or according to arrangement.
Postoperative pain depends on the grade of the disease, technique applied and individual pain threshold. The most painful period is during the first three postoperative days and it is important to take analgesics in time, i.e. immediately with occurrence of pain, according to the instructions of anesthesiologist.
After 10-14 days the patient is able to return to his daily activities and work. In the early postoperative period, one can expect mild gathering of the blood residue from the rectum. One should, therefore, pay attention to slowly getting up to sitting and standing position.
Nutritional recommendations include easy, digestible food without a lot of residue (soups, cooked meat and fish, mildly spiced, not fried; carbohydrates – potatoes, rice, pasta). Avoid fresh fruit and vegetables, cheese and milk, beans and food that cause flatulence. Take plenty of fluid. Do not force defecation; first stool should be expected after 2-3 days; perhaps enhance with Donat Mg.

Side effects and complications

With this excellent and effective method, potential risks are very serious, even fatal – if the procedure is performed in an inadequate institution by an incompetent surgeon; that is why they are performed only in polyclinics that have adequate conditions, technological and professional. Complications are: separation of the connected edges of intestines, bleeding, and pelvic abscess formation.

Package

Package includes: includes preoperative examination by an anesthesiologist, procedure itself, thromboprophylaxis if necessary, analgesics for 1-2 postoperative days and control examinations during the next 6 months.
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