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Patients with piles, now have a reason to smile. Piles or Haemorrhoids is a common condition that affects a significant part of the population. The condition is painful and unbearable. But most patients who need surgical help tend to suffer with the problem in silence than undergo surgery, as the post-operative pain is even more severe. Now all that will change. Procedure for Prolapse and Haemorrhoids (PPH) or Stapled Haemorrhoidectomy is the latest procedure in the treatment of piles or haemorrhoids. This procedure is miracle surgery for patients with piles as the procedure is short with a faster recovery period and very few postoperative complications. Postoperative pain, which is the most disabling complication after traditional piles surgeries, is minimal after this procedure.
Haemorrhoids are commonly known as piles is a common finding in majority of the population. They can be described as masses or clumps (cushions) of supporting tissue within the anal canal.
The terminal part of the large intestine is divided into the rectum, anal canal and the anus. The anus is the external opening of the gastrointestinal tract. The waste products of digestion are passed out of the body through the anus during defecation. This clump of supporting tissue has a large number of blood vessels within it. When these veins get dilated and engorged with blood, they descend downwards pulling with themselves the supporting tissue as well (haemorrhoids). As a result the nerve endings in the anal canal get stretched causing severe pain. The number of nerve endings is more in the terminal part of the anal canal towards the anus as compared to the rectum or the upper part of the anal canal. As a result the haemorrhoids near the anus are more painful (external haemorrhoids) as compared to the haemorrhoids near the rectum (internal haemorrhoids).
The treatment of piles depends on the severity of the symptoms presented by the patient. In cases where the symptoms are mild, the patient is advised rest, suppositories and fibre rich diet and stool softeners to avoid constipation. The patients are also prescribed local application of corticosteroid and lidocaine creams to reduce pain and swelling. Sitting in a tub with warm water (Sitz bath) also provides relief in such cases.
If the above conservative measures fail to alleviate the pain, then the following surgical measures are considered:
Surgical haemorrhoidectomy involves ligation of the base of the haemorrhoids and cutting of the internal haemorrhoids. The blood supply to the external haemorrhoids also gets cut during this procedure. Eventually they shrink and fall off or they are cut. The patient is kept under observation for a night and discharged the next day. The postoperative recovery takes 2 weeks as the procedure may cause wounds near the anus which are very painful for the patient. These wounds take time to heal.
The procedure is done under local anaesthesia. The surgeon inserts an instrument called anoscope into the anal canal. The instrument winds a rubber band at the base of the haemorrhoid. The blood supply to the haemorrhoid is cut causing it to shrink and fall off within a week’s time. 1-2 haemorrhoids can be treated at a time. For more haemorrhoids, either the procedure is done under general anaesthesia or repeated as above at intervals of 4-6 weeks.
It is also called as Procedure for Prolapse and Hemorrhoids or Circumferential Mucosectomy or Stapled Haemorrhoidopexy.
The procedure involves removal of the loose connective tissue and repositioning of the hemorrhoids within the anal canal. It is the procedure of choice in 3rd and 4th degree prolapse or minor hemorrhoids that have not cured by conventional methods. The procedure can be combined with conventional haemorrhoidectomy in few cases if required. The procedure is contraindicated in severe fibrotic piles in which physical repositioning is not possible. Also in enterocele and anismus, the procedure is not advised.
It is a short surgery of 30 minutes and can be performed under local anaesthesia with sedation or spinal or epidural anaesthesia. In few cases general anaesthesia may be required. The patient is made to lie on his stomach on the operation table or in the lithotomy position. No special preoperative preparation is required.
The patient does not consume anything after the midnight before surgery. Enema is given at night and before the surgery. The use of antibiotics is generally not required.
After the patient has been positioned and sedated, the anal opening is gently massaged and the obturator is inserted to dilate the canal. This prevents injury to the internal sphincter. The obturator is removed and reinserted along with the circular hollow tube called the dilator. This pushes the loose supporting tissue higher inside.
The base of the dilator has 4 slits through which it is anchored to the perianal skin with the help of 3-4 sutures. The stapler cuts off the circumferential ring of expanded supporting tissue trapped within the stapler and at the same time staples together the upper and lower edges of the cut tissue. We now have a tightened supporting tissue which holds the haemorrhoids in place.
During the healing of the cut tissues around the staples, scar tissue forms, and this scar tissue anchors the haemorrhoidal cushions in their normal position higher in the anal canal. The staples are needed only until the tissue heals. They then fall off and pass in the stool unnoticed after several weeks. Stapled haemorrhoidectomy is designed primarily to treat internal haemorrhoids, but if external haemorrhoids are present, they can be reduced as well.
Since the postoperative pain and discomfort is less the patient is usually discharged on the same day or the next day. Patients can resume their normal activities within a week’s time.
The procedure has very few complications. They include post PPH syndrome (inflammation of internal sphincters for which anti-inflammatory medications are given), bowel discomfort, slight bleeding, anal fissuring (tearing of the lining of the anal canal), narrowing of the anal or rectal wall due to scarring, persistence of internal or external haemorrhoids, and, rarely, trauma to the rectal wall. These complications occur only in very few cases.
“After three years of pain, difficulty walking, and an inability to work, I have finally entered a new hopeful and exciting chapter in my life. Because of the absolute impossibility of finding a facility that could help me, I searched on the internet and found my surgeon Dr Sarup an exceptional and experienced surgeon , a solution that has changed my life.
The surgery was painless for me. The rehabilitation was strict and very effective, the nursing and the support staff were all trained, kind and infinitely caring.”
Jones and George, From UK
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