Hemorrhoidopexy is also known a PPH
Hemorrhoidopexy is also known a PPH – Procedure for Prolapse and Hemorrhoids, Stapled Anopexy, Stapled Prolapsectomy and Stapled Mucosectomy.
The operation does not involve the removal of the hemorrhoids it involves removing a band of the tissue above the dentate line. This process reduces the blood supply to the hemorrhoids and trims the tissue available to prolapse. Studies have evaluated the two operations and in terms of effectiveness it appears that conventional surgery still has the upper hand. With statistics showing that rates of post operative prolapse being significantly more with Hemorrhoidopexy. However statements from patients commented that pain was less and return to normal activities of daily living was quicker with patients following Hemorrhoidopexy
The Hemorrhoidopexy Operation
The doctor who is performing the procedure will explain what they are going to do, and will ask for your written permission to perform the procedure. This procedure is performed on grade 3-4 hemorrhoids
- If you are happy that you understand both what procedure you are going to have done and have been told of the risks involved with the procedure then you can sign the relevant document.
- You will be asked to take your clothes off and put on a gown
- You will have discussed which anaesthetic is suitable for you and the anaesthetist will then either give you a general or spinal anaesthetic
- 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 hemorrhoids. ( it will seem all a bit undignified but you will have either a sheet or blanket covering you until the procedure begins
- You will have sterile drapes put over you to maintain a sterile field for the surgeon
- An antiseptic/bacterial solution will be painted around the perineal area to eliminate germs from the skin surface
- 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 hemorrhoids.
- The dilator will be above the level of the hemorrhoids as the idea of the equipment used is to remove a circular piece of the bowel tissue, donut shaped.
- A purse string suture is created around the circumference f the bowel tissue
- The top section of the stapling device is inserted above the purse string.
- The purse string suture is then tightened drawing the bowel inwards
- The two pieces of bowel are then stapled together. Thus having the effect of hoicking up the hemorrhoids inside the bowel.
- The circular piece of bowel tissue is removed with the stapling device
- The hemorrhoids have not been removed merely relocated further up the bowel where hopefully they will remain and not cause a problem
- Once the operation is completed non adhesive dressing will be placed on the wound site with dressing gauze and a large sanitary pad this will be taped in position
- You will be placed on your side after the procedure to cause your buttocks to press together helping with the pressure which reduces bleeding.
- 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 surgical opinion.
- 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
The procedure is painful however in the immediate post operative period not as painful as hemorrhoidectomy; 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 when you are discharged form hospital
- Make sure you are able to urinate easily after the procedure(go for a wee)
- 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 hemorrhoidectomy although research indicates return to activities of daily living is quicker with Hemorrhoidopexy. The pain is less as well although research indicates that reoccurrence rates are higher with the Hemorrhoidopexy. 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
- 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 hemorrhoids – the operation may not be effective
- Faecal (stool/ poo) incontinence – this can happen in the short term but usually sorts itself out 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)
- Narrowing of the lumen of the bowel (the internal scaring of the bowel has caused it to become smaller) causing dysfunction
