What is PPH pph treatment principle Johnson & Johnson minimally invasive hemorrhoid surgery (PPH), also known as anastomotic suprahemorrhoidal circumferential hemorrhoidectomy, is a new technique based on the theory of anal cushion, using anastomosis to treat cricoid prolapsed hemorrhoids. The Department of Endoscopic Surgery of Johnson & Johnson Medical Equipment Co., Ltd. in cooperation with Italian scholar Dr. Antonio Longo, successfully developed a hemorrhoid anastomosis in 1993, which is specially designed for the treatment of severe hemorrhoids of II-IV degree, without destroying the normal physiological function of the anal cushion and significantly shortening the operation time and greatly reducing postoperative pain. It is performed by circumferential excision of the rectal mucosa and submucosal tissues. It is an effective treatment for severely prolapsed internal hemorrhoids. PPH, or anastomotic hemorrhoidopexy, is suitable for all types of hemorrhoids, especially severe internal hemorrhoids and partial rectal mucosal prolapse. The principle is to preserve the anal cushion and perform instantaneous anastomosis while removing and anastomosing part of the internal hemorrhoid and the supra-hemorrhoidal mucosa and submucosal tissue in a circular fashion. It not only blocks the blood supply of hemorrhoids, but also fixes the slipped tissues in suspension and restores the pathological anorectum to its normal anatomical state. The PPH technique, also known as supra-hemorrhoidal circumferential hemorrhoidectomy, 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 procedure is performed by widening the anus and suturing the rectal mucosa in a loop about 4 cm above the dentate line (the junction line between the rectum and the anal canal), then inserting the PPH anastomosis into the anus, 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 the operation A specially designed circular anastomosis is inserted into the rectum through the anus, and the mucosa and submucosa of the lower rectal wall are circumferentially excised, and anastomosis is performed at the same time to lift the prolapsed anal cushion and restore the normal anatomical position of the 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 branches supplying the hemorrhoid nucleus are cut off, thus achieving the goal of radical treatment. The first step is to insert the PPH anastomosis into the pain-free zone about 4 cm above the junction line between the rectum and the anal canal for treatment. 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 mucosa and submucosa 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 the recurrence of hemorrhoids, and achieving the purpose of treatment. Technical advantages 1.Safety：No need to remove the anal cushion, which can retain 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 hemorrhoids, multivalve hemorrhoids, giant isolated hemorrhoids, internal hemorrhoids, external hemorrhoids, mixed hemorrhoids, circumferential hemorrhoids, embedded hemorrhoids, rectal mucosal prolapse, prolapse, etc. 5.Suitable objects: Because of less damage, it is especially suitable for middle-aged and elderly people, white-collar people who pay attention to efficiency and those who relapse from traditional treatment, and patients with mild prolapse and internal prolapse of rectal mucosa. Contraindications It is not recommended for pregnant women, children, patients with intractable constipation, pelvic tumors, portal hypertension, Buicka syndrome or those who cannot tolerate surgery. The traditional methods of internal hemorrhoid treatment, including sclerotherapy, 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 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 circumferentially remove the mucosa and submucosa of the lower rectal wall 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 cushion. The mechanism of the PPH procedure 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 the operation. The anal cushion tissue with fine discriminatory ability is preserved and the normal anatomical structure of the lower rectum is restored, which results in less trauma, less pain, faster recovery and fewer complications. Structural features In order to facilitate the suturing of the pouch, the nail 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. The treatment mechanism of PPH is to circumferentially remove a section of mucosa above the hemorrhoid 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 removing 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 indications for this procedure are stage III internal hemorrhoids, circumferential mixed hemorrhoids and low rectal mucosal prolapse. As a new treatment method, it is theoretically in line with modern hemorrhoid treatment principles because the tissue of the anal cushion area is not damaged, 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 for PPH Postoperative dietary care for constipation or diarrhea: Patients are generally required to start defecating around 48 hours after the procedure, once a day, with soft and mushy 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 the pain and facilitate the wound healing, and at the same time can prevent and reduce the occurrence of postoperative complications. 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 removes the anal cushion to a greater or lesser extent. As a result, some patients have different degrees of incontinence after surgery. What is the difference between PPH and traditional surgery 1. 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, ligates the internal hemorrhoids, has a trauma in the anus, requires a denudation process, and performs daily drug changes, fumigation, and medication changes after surgery. The wound hurts severely during defecation and can only heal gradually. In contrast, PPH surgery is performed 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 defecate normally, 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 method is to treat the cause. 2, PPH surgery due to the preservation of the anal cushion, no damage to the anal sphincter, no surgical incision in the anus, the maximum retention of the physiological function of the anal cushion, so it has: (1) no pain after surgery (2) short surgery time, less damage, fast recovery, (3) no damage to the anal sphincter, no fecal incontinence, anal stenosis (4) low recurrence rate of hemorrhoids, 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 spinal nerve sensory endings, so the pain is significantly reduced after surgery; 3.Since the incision is anastomosed at once, there is no opening, so the healing time is extremely shortened; 4.Since the size of the anastomosis is relatively fixed, and it is located in the rectal mucosa, theoretically, no anal stenosis due to skin scar contracture will occur; 5.Since there are supporting The operation is simple and standardized, which is easy to promote and evaluate the prognosis. Why PPH is not painful At present, the best treatment for hemorrhoids is PPH minimally invasive surgery, which is operated in the rectal cavity above the line and is a painless area. The patient feels no pain during the PPH minimally invasive procedure, and it also eliminates the root cause of hemorrhoids from occurring. The anorectal specialist also said that PP minimally invasive surgery is highly precise and the operation takes only 20 minutes, and the patient can have normal bowel movements within 24 hours after the operation, and there is no pain after the operation. There are 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 circumferential surgery is effective for some complex hemorrhoids, such as mixed hemorrhoids, circumferential hemorrhoids, severe hemorrhoid prolapse, and prolapse.