Hemorrhoidal prolapse & PPH procedure
Sunday, 12th August 2007
This is a case of a 67 years old male with history of chronic constipation (20 years) and chronic hemorrhoidal disease came to the office with rectal bleeding and a non-redicible anal mass.
On physical examination we found Grade IV hemorrhoidal disease.
We decide to perform a PPH procedure with an hemorrhoidal circular stapler (33 mm) kit.
Note the tissue removed.
This donut confirms the circular and complete resection of the defect.
On the postoperatory period the patient was in excellent condition without pain and without bleeding.
jeffrey
Sunday, 12th August 2007 at 3:25 pm
hi.
i think this might have been mentioned before, but i just wonder how do u take these pictures? obviously you would have been involved in the procedure? no? or were u just watching and had a great camera phone?
i mention camera phone because wouldn’t u want to be rather discreet or “secretive” to take patient pictures?
yes they are deidentified but do they know? (just wondering, not pointing fingers here or anything like that)
next, i have no idea what is PPH. maybe someone could enlighten me? (i saw haemarrhoids being removed, they were much more severe than that above, and the surgical trainee was using the cautherizer to cut them away bit by bit….
is PPH some novel method of doing things?
Jon Mikel Iñarritu
Sunday, 12th August 2007 at 8:24 pm
Dr. Jeff,
I take all this pictures with the agreement of the patient.
There are four objectives of this pictures:
1. It’s a way to explain my patients the datails of the procedure.
2. I’m able to show them to the students for teaching purposes.
3. I upload them to this site with educational purposes.
4. I usually show the pictures taken to my patients in the PO period so they can figure how was the procedure.
When I can’t take them because I’m too busy during surgery I ask the anesthesiologist or the nurse to take them for me; sometimes with a regular digital camera and sometimes with a cameraphone.
Regarding the PPH, or procedure for prolapsing hemorrhoids with stapler is a “novel” approach to the management of enlarged, prolapsing hemorrhoids. Rather than rely on excision of the complexes, the primary goal is to reduce the hemorrhoidal tissue and anoderm to the correct anatomical location within the anal canal. We use an hemorroidal circular stapler kit which includes: clear plastic anoscope, half-slit anoscope, suture threader, and the 33 mm stapler.
More information about PPH in This Post (Worst hemorrhoidal prolapse ever).
Leo
Thursday, 20th September 2007 at 9:41 am
Excellent information which includes the facts just as I needed. I will undergo a PPH in 2 weeks.
If the surgeon desires to take photos I would be fine with that as well.
Paulino
Saturday, 23rd August 2008 at 11:34 pm
It´s important to say that the Ferguson hemorroidectomy stills as the gold standard for treatment of hemorroids.
yusef
Tuesday, 30th September 2008 at 9:36 am
sir,
my elder sister suffering from pph,
she is suffering high swelling on her both legs and stomatch
is any treatment for this
with thanks
yusef
Fercho
Tuesday, 24th March 2009 at 2:12 pm
Hello to all
On 3.19.09
Had my first surgery. Yeahhh a Hemorroid PPH, THey did not itch only bleed a lot.
I was not knoced. Procedure took 20 minutes but as of today 3.24.09 the pain still there.
After surgery I was sedated and given OXY to pass the pain. DO NOT BITE IT DO NOT BREAK IT
Came home with a big pack in my rectum ( gauges and tape) I removed it the dirst night.
The following day the wife went to the drugstore again because there was a list of things to but for post surgery.
Towelletes with hazel, ointment, mineral oil, magnesia milk, cotton balls.
She also bought a lot of gatorades, jello and more liquid.
HINT # 1 Doctors should give you this list before the surgery so the wife is not worrying the following day.
Day one not able to PISS
Drank a lot of liquid.
Day two got the shits because of the Laxatives.
I gess the whole is not closed.
Piss with a weak stream on and off it still hurts
Day three eating more solid foods. Mash potatoes salads watermelon and other fruits. Drinking more fluid.
No solid stool.
Day four since I had all that food inside my digestive system I decided to go for another cup of Magnesia Milk.
6 hours later got the shits again.
The pain still there.
I read that the pain remains for 9 days, but I want to know when will i see my first solid Stool
Jason
Monday, 6th April 2009 at 2:00 pm
I had a hemorriodectomy 2 years. Worst pain of my life for 2-3 days after surgery, and for another 2-3 weeks every bowel movement was painful as well. I am to have PPH surgery on Friday. From what ive read its a much easier recovery with lots less pain. Boy i hope so!!!
eneas
Saturday, 8th August 2009 at 9:14 pm
I had a hemorrhoidectomy last December 24 in a public hospital. Post care was the worst I have ever had ,not to mention the pain, I was passing out of pain. I was not told that I was suppose to remove the glued/sticked bandages by myself – needless to say for 2 days even passing gas was a torture. Long story short – I would have never had the surgery if I had known the outcome of it – until today I have the sagging skin around the anus – completely disfigured and worst of all – I still have hemorrhoids. Thanks to a friend who saw me suffering in pain suggested me taking mineral oil – that has been the cure for my excruciating pain for the last 3 months. They still bleed and swell – summer is hell.
If I had been cut opened I think the doctors should have the obligation to do a plastic surgery at the same time in the area as well. I am traumatized, physically damaged and still in pain. I still need the surgery to undo what it has been done and fix it properly – laser surgery, maybe???? Any other option available and permanently effective???? I might just take a picture and send it for better analysis. Maybe it is not as bad as I describe but it certainly feels thousand folds worse to me.
Jim Harrison
Thursday, 8th October 2009 at 6:10 pm
I am due to go in for day surgery on the 29th Oct to have PPH treatment here in the UK. After reading some comments regarding the after effects of the treatment i would be lying if i said i was not worried about the procedure. I know ppl would say better to have it done than suffer with out having it done…but having had this problem for a number of years i’m not sure which is going to be worse…..
chris
Sunday, 11th October 2009 at 8:32 am
i had a hemorriodectomy almost 2 weeks ago here in Singapore hospital. i been suffering my piles almost 20yrs which i think still considering category 3 because i need to push manually. I was admitted in the hospital overnight after of surgery as i cannot urine. I felt i full of urine inside and could not really come out. So the duty doctor put me a urine catheter. On the following morning i force myself and waited for so long in the toilet to urine. luckily i dicharged on the day after urine and go home and rest bed whole day. The pain which really cannot explain i really suffered especially when i go toilet. i managed to pass motion after 3 days of operation with extreme pain. I felt i dont have choice anymore so i just take it. After 5days of operation i go back to hospital and complain to doctor why still painful. The doctor was surprice as he said the stapler after 3 days should able go back to normal but depending to individual he said. He poke my anus and check if anything wrong of the surgery but in my surprise he suggest me to admit in hospital for thorough check up, however my 2days staying in hospital they give me extra pain killer + the injection only. i discharged on sunday and continue rest at home. On monday it was already 4th day i never pass motion. i felt something stock above my anus and wanted to pass motion. On tuesday morning the same feeling cannot pass motion but i know the stole is there inside. So i apply a little force to come out. With mercy with sweating + extreme pain i managed to pass motion. My main complain now i noticed there is a skin outside my anus with open wound. It very itchy and every time i pass motion there is a blood. Anyone can tell me what is this? i am really screar now. Overall i am not happy of pos surgery which i think after of surgery i will be find and no more skin outside my anus. My operation going to 2weeks tomorrow but still itchy my anus. The doctor just give me an extension another 1 week of hospitalization leave and will be total of 3weeks already. I am hoping anybody can give advice what to do or is this normal skin. I am thinking to post in here website the picture after of surgery using stapler.
Debbie Smith
Thursday, 21st January 2010 at 8:17 pm
I am a 32 year old female and had developed hemroids after giving birth to two kids. I had the PPH procedure done 10 days ago. By no means was the recovery fun but it was very tolerable. The worst was the first 24 hours because I had to come home with a cathedar due to the swelling not allowing me to urinate…that was awful, but once it was removed, it wasn’t too bad. I would say it took all of five days to feel back to “normal.” My other complaint, I’ve been a little constipated since the surgery while taking stool softners and small laxitives. And the last thing you want is to strain when using the restroom. The BM itself doesn’t it’s after the BM you have such an uncomfortable feeling for a while. But all in all…not too bad. Good Luck for those that try it.