Hemorrhoidal prolapse & PPH procedure

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.

hemorrhoidal prolapse

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.

17 thoughts on “Hemorrhoidal prolapse & PPH procedure”

  1. I had mPPH surgery yesterday 12/21/11. Dr. Waghi Mando in Kenner, Louisiana performed. This was by far the easiest surgery I have ever encoountered. I was almost Poinless. Thje only pain I felt was rright after the surgery (in recovery) but the pain medicine was suffecient. I canno say enough about Dr. Waghi Mando, his staff, the hhopital staff. If any one outhere is uffering wih painful hemorroids pleas do not hesitate to have this procedure doen. Dont; suffer with these painful hemorroids like I did for 30 yrs because of fear of surgery. If I can answer questions about my experiience please do not hesitate to e-mail me.

    Scared to death Dm

  2. instead of paracetomol ask for tramadol .
    sorry to keep going on but i am trying to help you all and how im getting through the past week since my hemrroidoctomy .

    on a lighter note , i was able to drive my car today and being a automatic was such joy to be able to drive once again .

  3. if you do decide to take lactoues and laxatives together , do not try to pass wind unless you are on or by a toilet , because unfortunatley you will follow through .

    buy laddies tenna pads and double up on your briefs , and before you leave hospital try and ask then to provide you with surgical underwear .

    if you a re perscribed iburophen 400mg`s to take 3 times a day , ask if you can have deflenac 50mg instead as these will not constapate you like iburophen will or codien , try not to take oral morphien unless the pain is so sevre that you have to , as this will also cause sevre costipation. there is not much more advice i can give except try to persaud your hospital to let you take home a crutch to help you walk around , and try to move about as much as you can , dont laye in bed for days thinking it will make it easier.

    Also i hope you have an understanding husband or wife as the drugs and intense pain will cause you to become agressive and frustrated , and you will say some nasty things to those who love you who are trying to help you even if you think that they are not . Its a long tough few days until the pain starts to ease . I should know , i have called my poor wife things i cannot believe even i said to her , and i am usually a kind gental man .

  4. I had a full internal and external hemmroid octomany on grade 4 hemrroids . I was admitted on the monday and by tuesday afternoon after a pain urination i was alowed to go home .

    my first day home was plenty of sleep , pain killers and lactose . and i thought to myself this aint as bad as i thought it was going to be .

    But then day three came and i felt a passing o wind during the morning so i got out of bed and went to the loo thinking i wouls be ok …….oh how wrong i was , I felt like i was going to die the pain was so excrutiating and i was is in agonising pain and kept trying to resist straining . but i found i was straining involuntary which made it worse . I was ready to pass out and i was sobbing like a baby .

    my dear wife ran me a hot bath and i climbed into it while she fetched my pain killers and the morphien , but i was still wanting to to get back to the toilet as i could feel the pressure in my bowel . i rushed back to the toilet sat down and let out an almighty cry as if i was being tortured , and i just wanted to die and screamed i dont want to die like this and prayed to god to make it stop.

    once i finished i scrambled back to the hot bath took my morphien and pain killers and after twenty miniutes went o my bed , but the cramps and spasms in my bowel were just as bad as before and i had no controle over them . just as my wife phoned for the ambulance i had to make a dash for the loo once more and before i had time to pull down my underwaer and trousers i soiled my self which sent me into uncontrolled hysterics .
    so back into the bath i went while my poor wife had to clean up the mess in the toilet area.
    This carried on for a week untill my doctor percribed me diazapan and deflefenac , and more lactouse , all of which have helped but i will admit i did collaps on my living room floor yesterday in agony with no one around to help me so i started to panic untill my wife got home from work . i went to the loo and screamed blue murder untill i knew i had finished emptying my bowel and collasped on our bed and fell asleep drugged up on diazapan and morphien. my wife gave me a chocalate laxative which is senna based , and at about 3am i awoke feeling the need to use the loo . terrified of the pain i closed my eyes and to my suprise the only pain a i felt was the sting as i passed what seemed more like liquid than hard stools .

    So i took another bit of this chocalate before returning to bed at 6am , and again this evening i had the same experiance . I Now wish i had taken this laxactive mixed with my dosage of lactouse right from the start as even though i would still have experiance pain , it may have not have been as torturing or agonising as it was from the start .

    I do not now regret having the operation , but just wish i had been alot better prepared for the pain that i have experiance , i still have to go back and still have 3 little hemrroids to be treated , but i will opt for the shrinking injections and not another operation .

    I wish you all the best of recovery and i hope that thoses who have it done , do not have to suffer like i have had to .

  5. 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.

  6. 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.

  7. 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.

  8. 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…..

  9. 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.

  10. 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!!!

  11. 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

  12. 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

  13. It´s important to say that the Ferguson hemorroidectomy stills as the gold standard for treatment of hemorroids.

  14. 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.

  15. 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).

  16. 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?

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