New, Less Painful Surgery for Hemorrhoids

Since antiquity physicians have sought less painful ways to treat hemorrhoids. Today the itching, bleeding, and discomfort caused by hemorrhoids can usually be eliminated by simple office techniques. But when hemorrhoids are severe, surgery (hemorrhoidectomy) is often the best remedy. Unfortunately conventional hemorrhoidectomy, although highly effective, can be painful. In recent years new methods touted to be less painful, such as cryosurgery (freezing), laser surgery and Ultroid (direct current electrotherapy), have come and gone. Now a new operation has arrived, and this one is showing promise.

As we age, and as a result of the repetitive shearing forces of defecation, the anal mucosal lining tends to loosen and slide downward (prolapse). The vascularized cushions of the anus then protrude and cause symptoms. In 1998 Dr. Antonio Longo, an Italian surgeon, described a new operation which uses a circular surgical stapler to remove a ring of anorectal tissue above the hemorrhoids, which lifts and flattens the hemorrhoids in the anal canal. Some doctors like to call this a "face lift" for hemorrhoids. Internal hemorrhoidal tissue may be removed in the process, and blood vessels feeding the hemorrhoids are severed. External hemorrhoids are not removed by the Hemorrhoidal Circular Stapler, but may diminish and atrophy afterwards, or they may be surgically excised at the time of the procedure.

Dr. Grasso has been personally trained by Dr. Antonio Longo to perform the procedure. Dr Grasso is currently one of the very few Certified Preceptors to teach other surgeons the PPH Procedure.

Since the tissue removed is above the sensitive part of the anus, patients experience less pain and a faster return to normal activities as compared to conventional hemorrhoidectomy. Instead of the sharp pain of conventional hemorrhoidectomy patients may feel a dull but tolerable ache for a few days. In a recent study twenty percent of the patients returned to work one day after the operation and 99 percent of the patients made a full recovery within seven days. 93 percent of patients required no further therapy for their hemorrhoids. However, because this procedure is so new, it does not have the proven track record of conventional hemorrhoidectomy. Long term recurrence rates are not known. Potential complications include intraoperative hemorrhage, perforation of the rectum, separation of the staple line, postoperative bleeding, urinary retention, pelvic infection with need for colostomy, narrowing of the anus, persistent pain, fecal urgency and incontinence.

Hundreds of surgeons in Europe already use this new technique. More than a quarter million of these operations have been performed. The Proximate HCS (Hemorrhoidal Circular Stapler), manufactured by Ethicon Endo-Surgery, has been approved by the Food and Drug Administration and American Colon and Rectal Surgeons are quickly adopting the "stapled hemorrhoidectomy," known formally as the "Procedure for Prolapse and Hemorrhoids" or "PPH."
To read or print an informative eight page booklet about this new operation click on PPH.
To read the Article regarding the PPH Procedure on M.D. Today click here.
For more information about hemorrhoids click here.
To visit the PPH Website and get detailed information click here.