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Surgical Classification of Hemorrhoids


Hemorrhoids (piles) arise from congestion of veins around the anal canal. They are classified, depending on severity, into four degrees. First degree hemorrhoids bleed but do not prolapse outside of the anal canal; second degree prolapse outside of the anal canal, usually upon defecation, but retract spontaneously. Third degree hemorrhoids require manual placement back inside of the anal canal after prolapsing, and fourth degree hemorrhoids consist of prolapsed tissue that cannot be manually replaced and is usually strangulated or thrombosed. Symptoms associated with hemorrhoids include pain, bleeding, puritus ani (itching) and mucus discharge. In IV degree prolapse, the area where the rectal mucous membrane meets the anal skin (the dentate line) is positioned almost outside the anal canal, and the rectal mucous membrane permanently occupies the muscular anal canal.

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Non Surgical Treatment

In many cases hemorrhoidal disease can be treated by dietary modifications (High Fiber Diet), topical medications and soaking in warm water, which temporarily reduce symptoms of pain and swelling.  Please click the following link.  

Hemorrhoids - Non Surgical Treatment

 

In a certain percentage of cases, however, surgical procedures are necessary to provide satisfactory, long term relief. In cases involving a greater degree of prolapse, a variety of operative techniques are employed to address the problem.

Traditional Surgery 

The three major hemorrhoidal vessels are excised. In order to avoid stenosis (narrowing after surgery), three pear-shaped incisions are left open, separated by bridges of skin and mucosa. Ocassionallly these incisions are partially closed with sutures. 

Furgeson Technique

A retractor is used to expose the hemorrhoidal tissue, which is then removed surgically. The remaining tissue is either sutured or is sealed through the coagulation effects of a surgical device.  These operations are very effective, but they are also very uncomfortable and can be disabling for several weeks.

 

 

Stapled Hemorrhoidopexy (PPH Procedure)


Also known as Procedure for Prolapse & Hemorrhoids (PPH), Stapled Hemorrhoidectomy, and Circumferential Mucosectomy.

 

PPH is a technique developed in the early 90's that reduces the prolapse of hemorrhoidal tissue by excising a band of the prolapsed anal mucosa membrane with the use of a circular stapling device. In PPH, the prolapsed tissue is pulled into a device that allows the excess tissue to be removed while the remaining hemorrhoidal tissue is stapled. The staple line is placed above where the nerves that sense pain are found, so this is a remarkably comfortable operation.
 This restores the hemorrhoidal tissue back to its original anatomical position.  This stapling process also interupts the blood vessels that are responsible for the hemorrhoids.  Because of this, hemorrhoids continue to shrink for several weeks following the procedure. 

 
 

 

What are the Benefits of PPH over other Surgical Procedures?
1) Patients experience less pain as compared to conventional techniques.
2) Patients experience a quicker return to normal activities compared to those treated with conventional techniques.
3) Mean inpatient stay is lower compared to patients treated with conventional techniques.

Many patients are able to undergo this innovative procedure. The PPH Stapled Hemorrhoidectomy is usually performed as an outpatient, with minimal discomfort and a rapid recovery. 

           Please Click Here For An Animation Of PPH Hemorrhoid Surgery