PPH is a circular stapler hemorrhoidectomy, which is suitable for all types of hemorrhoids, especially patients with severe internal hemorrhoids and partial rectal mucosal prolapse. The principle is: retain the anal cushion, perform circular excision and anastomosis of part of the internal hemorrhoids and the mucosal and submucosal tissues above the hemorrhoids, and perform instant anastomosis at the same time. It not only blocks the blood supply of the hemorrhoids, but also suspends and fixes the slipped tissue, and restores the pathological anorectal canal to a normal anatomical state.
Principle of surgery
Use a special circular stapler to insert into the rectum through the anus, circularly remove the mucosa and submucosal tissue of the intestinal wall at the lower end of the rectum, and perform anastomosis while removing it, so that the prolapsed anal cushion is lifted up, and the normal anatomical position of the anal cushion is restored, playing a "suspension" role, while cutting off the arterial blood branch supplying the hemorrhoids, playing a "cut-off" role, thereby achieving the purpose of radical cure.
Traditional methods for treating internal hemorrhoids, including sclerosant injection, rubber band ligation, and various forms of surgical resection, are all aimed at treating the hemorrhoids themselves, aiming to shrink or eliminate the hemorrhoids.
The treatment theory of stapled circular hemorrhoidectomy is completely different from traditional methods. On the one hand, it avoids damage to the perianal skin and causes postoperative pain. On the other hand, it preserves the integrity of the anal cushion and avoids fine control of stool after surgery.
The mechanism of the PPH surgical method is to circularly remove the mucosa and submucosal tissue of the lower rectal intestinal wall above the prolapsed internal hemorrhoids near the upper edge of the internal hemorrhoids, and anastomose the distal and proximal mucosa at the same time, so that the prolapsed internal hemorrhoids and mucosa are suspended and pulled upwards and no longer prolapse. At the same time, because the artery supplying hemorrhoids from the superior rectal artery in the submucosal layer is cut off, the blood supply of hemorrhoids is reduced after surgery. Therefore, the exact name of this operation should be: Circular resection of the mucosa and submucosal layer above the hemorrhoids, anal cushion suspension.
materials used for circular staplers
PP-H is a modified polypropylene material, a homopolymer polypropylene with high molecular weight and low melt flow rate. It has a fine crystalline structure after β modification. It not only has excellent chemical resistance, high temperature resistance and good creep resistance, but also has excellent impact resistance at low temperatures. It increases the hydrostatic strength and improves the chemical resistance. According to the characteristics of PPH materials, PPH pipes and plates are made into corrosion-resistant equipment and are widely used in chemical, metallurgical and electronic fields. PPH pickling tanks and electrolytic cells are economical and durable, reduce equipment maintenance, and extend service life, with superior performance.
surgical steps
Step 1
Introduce a special circular anal canal dilator into the anus to reposition the hemorrhoidal prolapse or anal canal mucosal prolapse.
Step 2
Remove the inner part of the dilator, introduce the anoscope suture device, and suture the prolapsed mucosa according to the degree. This step is called "making a purse", and the condition of the purse can be determined according to the condition of hemorrhoidal prolapse.
Step 3
Unscrew the circular hemorrhoidal stapler, let the nail turner penetrate into the upper end of the purse string, and then tie the suture.
Step 4
Pull the suture to place the prolapsed mucosal layer into the cavity of the stapler, close the stapler, and since the stapler has a sharp knife and suture system, the prolapsed mucosa will be removed after the position is determined. Stay still for 30 seconds to suture and stop bleeding. Remove the dilator and stapler.
What are the complications of hemorrhoid circumcision?
In many informal hospitals, bleeding accidents occur during PPH surgery. Once severe bleeding occurs, it may endanger the life of the patient. Next, experts will introduce to you how to avoid bleeding after PPH surgery:
The common characteristics of bleeding are:
1. Bleeding time: mainly occurs within 24 hours after PPH surgery;
2. The amount of bleeding is large, each case is greater than 5 mL, and the color is dark red;
3. Under the transparent anoscope, it can be seen that the bleeding is mostly diffuse oozing.
Bleeding after PPH surgery can be divided into primary bleeding and secondary bleeding. The causes of these two types of bleeding are:
一. The main causes of primary bleeding are: 1. Instrument factors, such as poor quality of staples or cutters; 2. Technical factors of the surgeon, such as incomplete hemostasis after surgery, bleeding at the anastomosis site after surgery, no bleeding after compression and no suture to stop bleeding, or incomplete hemostasis during surgery or arterial vessels are compressed and closed after anastomosis. This type of bleeding often occurs within 12 hours after surgery.
二. Secondary bleeding is mainly caused by infection or staple detachment. Specifically:
1. The anastomosis position is too low, the hemorrhoids are edematous, the tension is too high, causing hemorrhoidal blood vessels to rupture and bleed, or the internal hemorrhoids are too large. Part of the anal cushion tissue is removed during the operation. When the patient defecates, some staples fall off and cause mucosal bleeding;
2. Part of the staples at the anastomosis are loose (seen during anoscopy bleeding);
3. Hematoma occurs under the anastomosis;
4. Anemia, hypoproteinemia, malnutrition lead to poor anastomosis healing, mucosal necrosis leads to staples falling off, etc.
Once PPH surgery is followed by massive bleeding, the following matters should be addressed:
1. Rapidly establish a venous channel to maintain circulating blood volume.
2. Suture across the anastomosis under a transparent anoscope to stop bleeding.
3. Continue anti-infection and hemostasis treatment after hemostasis.
Under normal circumstances, prevention of massive bleeding after PPH surgery is necessary. Prevention is critical. Common prevention methods include:
1. Improve the technical level of PPH operators. During the operation, the purse-string suture should not be too low or too high. If it is too low, it is easy to cause hemorrhoidal blood vessels to rupture and bleed or the staples to fall off and bleed. If it is too high, the shrinkage effect of hemorrhoids is limited. The suture depth should reach the submucosal layer. Be careful not to be too shallow or too deep to prevent recurrence or damage to surrounding organs.
2. When bleeding points are found during PPH surgery, hemostasis must be strictly stopped. No fluke mentality should be allowed. Ligation must be firm. Conventional "8" sutures can be made across the anastomosis at 3, 7, and 11 o'clock.
3. Anti-infection and hemostasis treatment are required after PPH surgery, and the course of treatment is preferably 5 to 7 days.
4. When patients start eating after PPH surgery, they can be given drugs to soften stools and rectal mucosal protectants to reduce the friction and bleeding of stools on the anastomosis.