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PPH – Procedure for Prolapse



Haemorrhoidopexy is also known as PPH – Procedure for Prolapse

Haemorrhoids, Stapled Anopexy, Stapled Prolapsectomy and Stapled Mucosectomy.

This operation does not involve the removal of the haemorrhoids themselves but it involves removing a band of the bowel tissue above the dentate line. This process reduces the blood supply to the haemorrhoids and trims the tissue likely to lead to prolapsed piles. 
Studies have evaluated the two operations and in terms of effectiveness it appears that conventional surgery remains the gold standard. Statistics showing that rates of post-operative prolapse are significantly more with Haemorrhoidopexy, however statements from patients commented that pain was less and return to activities of daily living was faster with patients following Haemorrhoidopexy

The Haemorrhoidopexy operation

The doctor who is performing the procedure will explain what they are going to do, and will ask for your written consent to perform the procedure. This procedure is performed on grade 3-4 haemorrhoids

  1. If you understand both what procedure you are going to have performed and have been told of the risks involved with the procedure then you sign the consent form
  2. You will be asked to remove your clothes and put on a gown
  3. Prior to going to theatre you will have discussed which anaesthetic is suitable for you with the anaesthetist.
  4. You will be escorted to the theatre where you will then have either a general or spinal anaesthetic
  5. You will be positioned either on the operating table with stirrups for your feet called the lithotomy position. Or on your front with your bottom raised it will depend on the location of the haemorrhoids. ( it will seem all a bit undignified but you will have either a sheet or blanket covering you until the procedure begins
  6. You will have sterile drapes put over you to maintain a sterile field for the surgeon
  7. An antiseptic/bacterial solution will be painted around the perineal area to eliminate germs from the skin surface
  8. An instrument called a Circular Anal Dilator will be gently placed in your anus so the doctor will be able to have a good view the haemorrhoids.
  9. The dilator will be above the level of the haemorrhoids as the idea of the equipment used is to remove a circular piece of the bowel tissue, donut shaped.
  10. A purse string suture is created around the circumference of the bowel tissue
  11. The top section of the stapling device is inserted above the purse string.
  12. The purse string suture is then tightened drawing the bowel inwards
  13. The two pieces of bowel are then stapled together. Thus having the effect of drawing up the haemorrhoids inside the bowel.
  14. The circular piece of bowel tissue is removed with the stapling device
  15. The haemorrhoids  have not been removed merely relocated further up inside  the bowel where hopefully they will remain and not cause a problem
  16. once the operation is completed a large sanitary pad will be taped in position
  17. You will be placed on your side after the procedure to cause your buttocks to press together helping with the pressure which reduces bleeding.
  18. When you are in recovery the wound site will be inspected frequently to check on bleeding a small amount is expected but larger quantities may require a surgical opinion.
  19. 24 hours after the operation the dressings will be removed and you will be encouraged to take a bath.

Normal bowel habits should be resumed as soon as possible, and you will be encouraged to eat fibre rich foods and drink plenty of fluids. The first bowel movement is often dreaded due to pain however it is important that you open your bowels regularly to prevent constipation.

Post-operative pain following Haemorrhoidopexy

The procedure is painful however in the immediate post-operative period not as painful as haemorrhoidectomy; you will be given pain relief to take. This needs to be taken regularly to be effective. Pain can persist for up to two weeks postoperatively.

Special precautions

  • Ensure you have adequate pain relief available to you; if you are uncomfortable ask the nursing staff for additional pain relief.
  • Make sure you have someone available to help you at home when you are discharged form hospital for the next 24 hours
  • Make sure you are able to urinate easily after the procedure(go for a wee) before you leave the hospital
  • Maintain a good  fluid intake
  • Try and do some gentle exercise, do not lie in bed or on the couch all the time
  • Take any stool softener or laxatives you have been prescribed
  • Eat plenty of fibre rich foods so you do not become constipated
  • Do not do any heavy lifting for at least two weeks
  • Maintain a good hygiene regime wash after each bowel movement

Healing / recovery time

The healing time is similar to that of haemorrhoidectomy although research indicates return to activities of daily living is quicker with Haemorrhoidopexy. Research shows that the pain is measurably less although it also indicates that reoccurrence rates are higher with the Haemorrhoidopexy.
The initial healing takes approximately two weeks until you feel more comfortable. Most people will takes two weeks off work for recovery but may not be able to return to work for a month depending on the type of work you do. You may be able to discuss reduced hours with your employer so you are able to resume work gradually.

Complications and risks

  • Pain - you may find that having your bowels open may continue to cause you pain and you may experience faecal urgency
  • If too much muscle tissue is drawn into the stapling device damage to the rectal wall may occur
  • Bleeding – a post-operative bleed can sometimes take place unexpectedly days after the operation you will need to consult your doctor is this is excessive
  • Infection - the internal stapled bowel surface may become infected, you will experience a foul smelling discharge with pus if this occurs, pelvic sepsis can occur
  • Return of the haemorrhoids – the operation may not be effective
  • Faecal incontinence (stool/ poo)  – this can happen in the short term  but usually resolves  if not you will need to see your doctor
  • Inability to pass urine (wee) – this is something that might happen immediately post operatively and would be rectified at the hospital
  • Anal Fistula / Fissure (a narrow track from inside the bowel to the skin surface) This may occur due to infection
  • Narrowing of the lumen of the bowel (the internal scaring of the bowel has caused it to become smaller) causing dysfunction




Please Note: The information provided here should not be used for diagnosis or treatment of any medical condition. A medical practitioner should always be consulted for diagnosis and treatment of all medical conditions.

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