pph treatment principle Minimally invasive hemorrhoid surgery (PPH), also known as anastomotic suprahemorrhoidal circumferential hemorrhoidectomy, is a new technique based on the doctrine of the anal cushion, using anastomosis to treat cricoid prolapsed hemorrhoids. It was first developed by Dr. Antonio Longo, an Italian scholar, and is a hemorrhoid anastomosis used to treat 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 tissue. It is an effective treatment for severely prolapsed internal hemorrhoids. To date, 300,000 hemorrhoid patients have successfully undergone PPH surgery worldwide, and in China, nearly 15,000 patients have successfully undergone the procedure since it was performed in 2000. In China, nearly 15,000 patients have undergone the procedure since it was performed in 2000. We have been performing the procedure since 2003 and have performed nearly 1,000 successful cases. The PPH technique is a new technique based on a 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 hemorrhoids using a special instrument called the PPH anastomosis. The anus is first opened and the rectal mucosa is sutured in a loop about 4 cm above the dentate line (the junction line between the rectum and the anal canal), and then the PPH anastomosis is inserted into the anus, and the anastomosis can remove the prolapsed mucosal band, and the whole procedure only takes 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, which 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 surgery. Scope of application】 Disposable anal hemorrhoid anastomosis clutch is suitable for the treatment of rectal mucosal prolapse or hemorrhoidal tissue stapling repair in the anal canal, and for the treatment of Ⅲ and Ⅳ degree internal hemorrhoids. 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 mucosa removal is a non-open wound with little bleeding, eliminating the need for post-operative medication changes and allowing a quick return to normal life. 4.Clinical hemorrhoids, multivalve hemorrhoids, huge isolated hemorrhoids, internal hemorrhoids, external hemorrhoids, mixed hemorrhoids, ring hemorrhoids, embedded hemorrhoids, rectal mucosal prolapse, prolapse, rectal prolapse, etc. 5.Suitable object: 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 with traditional treatment and patients with mild prolapse and rectal mucosal prolapse. Contraindications】 It is not recommended for pregnant women, children, those with persistent constipation, pelvic tumors, portal hypertension, Bucca 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, are all aimed at treating the hemorrhoid itself, with the aim of shrinking or eliminating 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: supra-hemorrhoidal mucosal and submucosal circumcision and anal pad suspension. 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 from the superior rectal artery supplying the hemorrhoid is cut off in the submucosa, the blood supply of the hemorrhoid 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, so the patient has less trauma, less pain, faster recovery and fewer complications after the operation. Structural features】 In order to facilitate the suturing of the pouch, the nail holder assembly and the anastomosis body are designed as separate structures, and then the two are docked during the anastomosis, which is convenient for operation. The treatment mechanism of PPH is to circumferentially excise 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. 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 said that some cases had recurrence after 16 months. Post-operative care for PPH] Post-operative dietary care for constipation or diarrhea: After the operation, patients are generally required to start defecating around 48 hours, 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 too 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 much 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 surgery, it will not only make the surgery go smoothly, but also play an important role in the repair of the wound, which can also reduce the pain and facilitate the wound healing, as well as prevent and reduce the occurrence of post-operative complications. PPH and traditional surgery for hemorrhoids comparison] 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 hemorrhoid nucleus by external peeling and internal ligation is the most common treatment for severe hemorrhoids in recent years, but the post-operative pain and longer hospitalization and healing time associated with traditional surgical treatment often make patients shy away from it, 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, there are patients with varying degrees of postoperative incontinence.