Are You a Good Candidate for Procedure for Prolapse and Hemorrhoids (PPH)?
Most hemorrhoids clear up with conservative treatment, and the bleeding, itching, and pain go away within a week or two. This includes increasing the fiber in the diet, drinking more water, and using topical medications and sitz baths to lessen the inflammation.
When this doesn’t work, or if your hemorrhoids prolapse or thrombose, you may need medical treatment. This could include an in-office procedure such as rubber band ligation, or a more invasive surgical procedure like procedure for prolapse and hemorrhoids (PPH) or a hemorrhoidectomy.
Who Needs Surgery for Hemorrhoids?
Only a small minority of patients, about 5 to 10 percent, require surgical intervention for their hemorrhoids. Most of these patients either fail to respond to conservative treatment, have recurring symptoms, or suffer severe symptoms related to Grade III or IV hemorrhoids.
When a patient does require surgery, a hemorrhoidectomy has long been the gold standard. During this procedure, a surgeon excises the offending tissue and either stitches the incision closed or packs it with gauze while it heals. More and more surgeons today, however, are opting for the procedure for prolapse and hemorrhoids (PPH) when possible. This procedure offers considerably less post-operative pain and a faster return to work and other activities than a traditional hemorrhoidectomy.
Who Is the Ideal Candidate for PPH?
PPH, sometimes called a stapled hemorrhoidopexy or stapled hemorrhoidectomy, is not an option for everyone who needs hemorrhoid surgery. Those with large Grade III and IV hemorrhoids may not be a good candidate, and those whose hemorrhoids involve the entire anal circumference may not qualify.
An ideal PPH candidate will have:
- Prolapsing hemorrhoids near the anal opening;
- Symptomatic Grade II hemorrhoids that did not respond to other treatments; and/or
- Grade III or IV hemorrhoids, depending on their location and size
What Is PPH?
During PPH, the surgeon uses a special circular staple gun to perform the procedure. This means you will not have any external incisions, which are often the most painful part of a traditional hemorrhoidectomy. PPH also offers a lower complication rate than a traditional procedure, and a quicker recovery time.
You will still need to receive anesthesia, or at least a pain block, before a PPH. Like traditional surgery, your surgeon will perform it in a surgical suite in an out-patient clinic or the hospital. At our clinic, we used two trained and experienced surgeons for each procedure. This reduces the risk of either surgeon falling victim to any technical challenges during the PPH. We always have at least one colon and rectal specialist in the surgical suite during these procedures working in tandem with another surgeon.
Most people can go home a few hours after a PPH, although some may need to stay overnight if they have certain risk factors. You may be able to return to work in a few days, and full activities within two weeks.
A Great Option, for the Right Patient and With the Right Surgeons
A traditional hemorrhoidectomy is still the most effective treatment for severe or recurrent hemorrhoids. However, the popularity of PPH and other alternative procedures has increased in recent years. Patients may have a slightly higher risk of recurrence, but they experience much less post-operative pain and a much shorter recovery. If their hemorrhoids do recur, most respond to conservative treatment and very few require additional surgery.
In general, if you are a strong candidate, procedure for prolapsing hemorrhoids provides a good alternative to traditional surgical techniques. If your doctor has mentioned you may need surgery for your hemorrhoids, ask them if you might qualify for PPH.
It is important to note, however, that it takes a competent and experienced surgeon to perform a stapled hemorrhoidectomy properly. This can be a challenging procedure for doctors who do not perform them often, and mistakes can lead to post-operative complications. For this reason, we highly recommend discussing whether you are a candidate with a colon and rectal specialist.