Minimally invasive hemorrhoid surgery (PPH), also known as anastomotic supra-hemorrhoidal mucosal circumferential hemorrhoidectomy, is a new technique based on the theory of the anal cushion, using the anastomosis to treat cricoid prolapsed hemorrhoids.
In 1993, we successfully developed a hemorrhoid anastomosis specifically for the treatment of severe hemorrhoids of degree II-IV, which does not destroy the normal physiological function of the anal cushion and significantly shortens the operation time and greatly reduces postoperative pain. It is performed by circumferential resection of the rectal mucosa and submucosa. It is an effective treatment for severe prolapsed internal hemorrhoids. To date, 300,000 hemorrhoid patients worldwide have successfully undergone PPH surgery, and in China, nearly 15,000 patients have successfully undergone the procedure since its inception in 2000.
PPH], or anastomotic hemorrhoid circumcision, is suitable for all types of hemorrhoids, especially for patients with severe internal hemorrhoids and partial rectal mucosal prolapse. The principle is that the anal cushion is preserved and a portion of the internal hemorrhoid and the supra-hemorrhoidal mucosa and submucosal tissues are instantly anastomosed along with circumferential excision and anastomosis. It not only blocks the blood supply of hemorrhoids, but also suspends and fixes the slipped tissues, restoring the pathological state of the anorectum to its normal anatomical state.
Effectiveness of PPH treatment
The pathogenesis of hemorrhoids is mainly a problem with the “anal cushion”. Traditional treatment is mostly aimed at hemorrhoids themselves, and although it is effective to some extent, it is not ideal, and the rate of symptom relief after surgery is low; or even if temporary relief is achieved, the symptoms are likely to recur after 1 or 2 years.
PPH surgery is different from the traditional treatment, it does not directly deal with the hemorrhoid itself, but uses a special instrument imported from the United States to remove the prolapsed rectal mucosa above the hemorrhoid in a circular fashion, and also blocks the terminal anastomotic branch of the terminal rectal artery, thus eliminating the root cause of the hemorrhoid, so the effect is more ideal. Especially for some types of hemorrhoids that are very difficult to treat with traditional treatment, such as mixed hemorrhoids, ring hemorrhoids, severe hemorrhoid prolapse, prolapse, etc., PPH surgery is also very effective.
PPH technology
This is a new technique based on the new understanding of the pathogenesis of hemorrhoids caused by anal cushion lesions. The PPH procedure is a circular excision of the prolapsed rectal mucosa above the hemorrhoid. The anus is first opened, and the rectal mucosa is sutured in a loop at about 4 cm above the dentate line (the junction line between the rectum and the anal canal), then the PPH anastomosis is inserted into the anus, and the anastomosis can remove the prolapsed mucosal band, and the whole procedure takes only about half an hour. Since the rectal mucosa above the dentate line is innervated by visceral nerves, patients have almost no pain after the operation; and since the operation not only removes the prolapsed rectal mucosal band, but also blocks the terminal anastomotic branch of the terminal rectal artery, eliminating the root cause of hemorrhoids, it has very ideal treatment effects on internal hemorrhoids, external hemorrhoids, mixed hemorrhoids, circular hemorrhoids, severe hemorrhoid prolapse, prolapse, etc. It has the characteristics of quick effect, quick recovery and no pain after the operation.
Scope of application
It is ideal for the treatment of internal hemorrhoids, external hemorrhoids, mixed hemorrhoids, circumferential hemorrhoids, severe hemorrhoid prolapse, prolapse, etc. It is used for the treatment of III and IV degree internal hemorrhoids.
Principle of surgery
A specially designed circular anastomosis is inserted into the rectum through the anus, and the mucosa and submucosa of the lower rectal wall are removed in a circular fashion, and anastomosis is performed at the same time to lift the prolapsed anal cushion and restore the normal anatomical position of the anal cushion, which plays the role of “suspension”, while the arterial blood branches supplying the hemorrhoids are cut off, which plays the role of “disconnection”. “At the same time, the arterial blood supply to the hemorrhoid nucleus is cut off, thus achieving the purpose of radical treatment.
Surgical steps
In the first step, the PPH anastomosis is inserted into the pain-free zone about 4 cm above the junction line between the rectum and the anal canal.
In the second step, the PPH anastomosis is completed instantly by circumferential excision of about 3 to 4 cm in part of the internal hemorrhoid and the mucous membrane and submucous layer of tissue over the hemorrhoid, while the anastomosis is completed instantly, blocking the bleeding of the hemorrhoid supply vessels and at the same time suspending the slipped tissue upward to fix it.
In the third step, the vascular supply of hemorrhoids is cut off and the internal and external hemorrhoids automatically shrink, thus eliminating the root cause of hemorrhoids and avoiding their recurrence for the purpose of treatment.
Technical advantages
1.Safety: No need to remove the anal cushion, which can preserve the normal function of the anus to the greatest extent and avoid complications such as anal stenosis and anal incontinence.
2, Painless: Pulling the hemorrhoid out of the anus back to its original position, while truncating the blood vessels that provide blood to the hemorrhoid, without damaging the perianal skin, so there is almost no pain after the operation.
3.Little trauma and quick recovery: The anastomosis circumferential resection of mucosa is a non-open wound with little bleeding, which eliminates the trouble of changing medicine after surgery and allows you to resume normal life soon.
4.Clinical hemorrhoid, multivalve hemorrhoid, huge isolated hemorrhoid, internal hemorrhoid, external hemorrhoid, mixed hemorrhoid, circumferential hemorrhoid, embedded hemorrhoid, rectal mucosal prolapse, prolapse, etc.
5.Suitable objects：Since there is less damage, it is especially suitable for middle-aged and elderly people, white-collar people who pay attention to efficiency and those who relapse with traditional treatment, and patients with mild prolapse and rectal mucosal prolapse.
Contraindications
It is not recommended for pregnant women, children, patients with persistent constipation, pelvic tumors, portal hypertension, Bucca syndrome or those who cannot tolerate the surgery.
Mechanism of surgery
Traditional methods of internal hemorrhoid treatment, including sclerotherapy injections, rubber band ligation, and various forms of surgical excision, all target the hemorrhoid itself and aim to reduce or eliminate the nucleus. Clutch circumferential hemorrhoidectomy is completely different from the traditional methods in terms of treatment theory, avoiding damage to the perianal skin causing postoperative pain on the one hand, and preserving the integrity of the anal cushion on the other hand, avoiding fine bowel control disorders after surgery.
The mechanism of PPH surgery is to remove the mucosa and submucosa of the lower rectal wall circumferentially above the prolapsed internal hemorrhoid near the upper edge of the internal hemorrhoid, and to anastomose the distal and proximal mucosa at the same time, so that the prolapsed internal hemorrhoid and mucosa are suspended and pulled upward and no longer prolapse. At the same time, the artery supplying the hemorrhoid from the superior rectal artery in the submucosa is cut off, and the blood supply to the hemorrhoid is reduced after the operation. Therefore, the exact name of the procedure should be: supramucosal and submucosal circumcision of hemorrhoids and suspension of the anal pad.
Mechanistic features
The mechanism of PPH surgery is to remove the mucosa and submucosa of the lower rectal wall circumferentially above the prolapsed internal hemorrhoid near the upper edge of the internal hemorrhoid, and to anastomose the distal and proximal mucosa at the same time, so that the prolapsed internal hemorrhoid and mucosa are suspended and pulled upward and no longer prolapse. At the same time, because the artery supplying hemorrhoids from the superior rectal artery in the submucosa is cut off, the blood supply of hemorrhoids is reduced and tends to become smaller after surgery to preserve the anal cushion tissue with fine discriminatory ability and restore the normal anatomical structure of the lower rectum, which results in less trauma, less pain, faster recovery and fewer complications for the patient after surgery.
Structural features
In order to facilitate the suturing of the pouch, the staple holder assembly and the anastomosis body are designed in the form of separate structures, and then the two are docked during the anastomosis, which is convenient for operation.
Precautions for PPH surgery
The treatment mechanism of PPH is to circumferentially excise a section of mucosa above the nucleus, and at the same time anastomose the rectal mucosa near and far, so that the prolapsed anal cushion tissue can be lifted up, in addition, because the blood supply is partially blocked while excising and anastomosing the mucosa, so that the blood vessels in the overly enlarged and dilated anal cushion area can be partially atrophied due to the reduction of blood supply, thus achieving the purpose of stopping its prolapse. The best indication for this treatment should be stage III internal hemorrhoids, cyclic mixed hemorrhoids, and concomitant low rectal mucosal prolapse is also an indication.
As a new treatment method, it is theoretically in line with modern hemorrhoid treatment principles, since the tissue of the anal cushion area is not damaged and its reflex to defecation is not affected, and the closing and pressure-boosting effect of the anal cushion on the anus is not affected. From the results of the operation, the recent results are good.
The problem is that the method has not been introduced into China for a long time, so the long-term efficacy remains to be observed, and there are some complications, such as postoperative hemorrhage and anastomotic infection, etc. In addition, we have found from some reports that some complications are quite serious, including intestinal fistula, rectovaginal fistula, pelvic infection leading to sepsis, and there are also reports of death. Some overseas experts have described that some cases have recurrence after 16 months.
Postoperative care of PPH
Dietary care for postoperative constipation or diarrhea: After the procedure, patients are usually asked to start defecating around 48 hours, once a day, with soft, burnt stools to avoid damage and increased pain caused by friction when the stool is discharged through the trauma. If there is no bowel movement 3 days after the operation, the patient is instructed to increase some foods containing vegetable fats, such as sesame, broth, etc. A small amount of sesame oil or honey can also be taken with boiling water at night before bedtime, and after the above dietary therapy, the stool can generally be discharged. If it cannot be discharged, a small enema with open cork can be used. If diarrhea occurs after surgery, the patient should be instructed to eat light, easily digestible food, pay attention to dietary hygiene, and forbid eating raw and cold. And drink strong tea to facilitate urination and make the stool take shape, and if necessary, use antidiarrheal drugs.
Dietary care for postoperative defecation difficulties: on the day after surgery or the second day, mostly due to anesthesia, surgical stimulation, wound pain or dressing compression, causing reflex bladder neck sphincter pain, spasm caused by postoperative urinary difficulties. Such patients should drink strong tea or sweetened water to increase the volume of urine, stimulate the bladder and enhance the desire to urinate, or relax the dressing that compresses the wound to promote urination. If you are still unable to urinate, you should be given catheterization as prescribed by your doctor.
Diet structure is closely related to healing hemorrhoids. If the food is too fine and refined, it will slow down the intestinal peristalsis, cause constipation and lead to varicose veins in the anorectal area; if too much chili or pepper is consumed in the food, it will stimulate the anorectum and cause congestion and expansion of blood vessels in the anorectal area; if too much diet is consumed or too coarse food is consumed, it will easily cause too many stools after surgery and cause wound infection; if the diet is properly regulated before and after surgery, it will not only make the surgery go smoothly If the diet is properly regulated before and after the operation, it not only can make the operation go smoothly, but also play an important role in the repair of the wound, and can reduce pain and facilitate wound healing, and at the same time can prevent and reduce the occurrence of postoperative complications.
(1) Diet: liquid or semi-liquid diet on the first postoperative day, and ordinary diet on the next day.
(2) Defecation: controlled defecation for 1 day after surgery, and oral liquid paraffin oil or hemp pills to soften the stool and sit in a bath after defecation. No need to change medication, no need to incorporate suppositories etc. in the anus.
(3) The use of antibiotics: general postoperative prophylactic application of antibiotics for 1 to 3 d to prevent anastomotic infection.
(4) Observation and treatment of complications: If the operation is standardized, there are generally no recent complications, but on the contrary, there are bleeding, anal pain and distant anastomotic stenosis, etc. Therefore, blood pressure and pulse should be closely monitored within 24h after surgery, and the stenosis should be dilated if necessary.
PPH versus traditional surgery for hemorrhoids
Non-surgical treatment: diet therapy, oral medication, external medication, injection therapy, withered hemorrhoid therapy, infrared therapy, cryotherapy, laser therapy, etc.
Traditional surgical treatment: Removal of the hemorrhoid nucleus by external peeling and internal ligation is the most commonly used treatment for severe hemorrhoids in recent years, but the post-operative pain and longer hospitalization and healing time associated with traditional surgical treatment often scares patients, and there is a certain possibility of recurrence with traditional surgical treatment, especially important because it more or less removes the anal cushion. As a result, there are patients with varying degrees of incontinence after surgery.
What is the difference between PPH and traditional surgery?
The surgical site is at the anal opening, while the PPH surgical therapy site is in the lower rectum. Traditional surgery removes the external hemorrhoids and ligates the internal hemorrhoids, which are traumatized in the anus and require a denudation process, with daily medication changes, fumigation, and drug changes after surgery. The wound is extremely painful during defecation and can only heal gradually. In contrast, the PPH surgery site is in the lower rectum, and the anastomosis is performed at the same time, and the whole procedure takes only a few minutes, preserving the anal cushion tissue, with no trauma in the anus and no denucleation process. The first day after the operation, you can have normal bowel movement, and there is no need for special drug changes and fumigation. Traditional surgery requires cutting the sphincter to prevent anal stenosis, but PPH surgery does not damage the sphincter, so no anal stenosis or fecal incontinence will occur. Traditional surgery is symptomatic treatment, while PPH surgery is to treat the cause of the disease.
PPH surgery has the following features because it preserves the anal cushion, does not damage the anal sphincter, has no surgical incision in the anal part, and retains the physiological function of the anal cushion to the maximum extent.
1.No pain after surgery
2.Short operation time, small injury, fast recovery
3.No damage to the anal sphincter, no incontinence, anal stenosis
4.Low recurrence rate of hemorrhoids and beautiful appearance
Why PPH has advantages?
1.Since the anal cushion is not removed, the fine defecation function is not affected after surgery.
2.Since the incision is above the dentate line, there is no crestal nerve sensory endings, and the postoperative pain is obviously reduced.
3.Since the incision is a single anastomosis with no opening, the healing time is extremely shortened.
4.Since the anastomosis is relatively fixed in size and located in the rectal mucosa, theoretically, no anal stenosis due to skin scar contracture will occur.
5.Since there are supporting instruments, the operation is simple and standardized, which is easy to promote and evaluate the prognosis.
Why PPH does not hurt
At present, the best method to treat hemorrhoids is PPH minimally invasive surgery, which is operated in the rectal cavity above the line and is a painless operation. The patient feels no pain during the PPH minimally invasive procedure, and it also eliminates the root cause of hemorrhoids and prevents them from occurring.
PP minimally invasive surgery is highly precise and the procedure takes only 20 minutes, and the patient can have normal bowel movements within 24 hours after the procedure, and there is no pain after the procedure. There are even no complications. Because the PPH procedure addresses the root cause of hemorrhoids, the immediate and long-term results are ideal and will not recur. PPH circumcision is effective for some complex hemorrhoids, such as mixed hemorrhoids, circumferential hemorrhoids, severe hemorrhoid prolapse, and prolapse.
What is Analtech Smart PPH surgery
The anastomotic staples used in traditional analtech smart PPH surgery are made of ordinary titanium metal, and after use the anastomosis is fixed in the peristaltic intestinal cavity and cannot move at the same time, leading to many complications of bleeding or rectal stricture.
The Anotai Smart PPH technology uses nickel-titanium alloy anastomosis staples with shape memory, which can use the natural pressure in the intestinal lumen to complete the anastomosis process so that the intestinal lumen can regain its natural lumen size and elasticity, allowing the postoperative complications of traditional Anotai Smart PPH to be resolved accordingly.
This technology is a replacement device for the Analtech Smart PPH, which is jointly developed by Analtech and a joint venture supplier to provide core technology.
Are there any after-effects of PPH surgery?
In the traditional hemorrhoid surgery is not considered the most difficult, but is most patients do not want to face. Perhaps none of the procedures will leave many hemorrhoid patients who have had surgery with palpitations, leaving those who are about to plop down on the operating table distracted.
The PPH procedure, also known as supra-hemorrhoidal circumferential hemorrhoidectomy, is a circular excision of the prolapsed rectal mucosa above the hemorrhoid using a surgical instrument called the PPH anastomosis, which is characterized by less bleeding, less pain, and faster recovery. It is the best hemorrhoid surgery ever, and the technique is not foolproof, but the claim that it is the best hemorrhoid surgery in comparison is certain.
PPH is performed by circumferential excision of the rectal mucosa and submucosal tissues. It effectively treats severe prolapse. So far 300,000 hemorrhoid patients around the world have successfully undergone PPH surgery, and in China, nearly 1,500 patients have successfully undergone the procedure since it was launched, and after the surgery, there are no after-effects.
PPH, or anastomotic hemorrhoidopexy, is suitable for all types of hemorrhoids, especially for patients with severe internal hemorrhoids and partial rectal mucosal prolapse. The principle is that the anal cushion is preserved and an instantaneous anastomosis is performed along with the circumferential excision and anastomosis of part of the internal hemorrhoid and the mucosa and submucosa tissue on the hemorrhoid. It not only blocks the blood supply of hemorrhoids, but also suspends and fixes the slipped tissues, restoring the pathological state of the anorectum to its normal anatomical state.
There are no after-effects of PPH surgery, that is for sure. However, hemorrhoids can still recur for those patients who do not abstain from eating and do not pay attention to conditioning and prevention after surgery. Therefore, after hemorrhoid surgery, it is important to focus on conditioning and prevention so that hemorrhoids do not recur and are completely eradicated.