Colon and Rectal Surgeons of Long Island, PC
Procedure for Prolapse and Hemorrhoids,
a New, Less Painful Operation 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.
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
Hundreds of surgeons in Europe already use this new technique.
More than half a million of these operations have been performed
worldwide, as of January, 2003.
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."
Dr. Leiboff was the first surgeon to perform the Procedure for Prolapse and
Hemorrhoids (PPH) in Suffolk County.
To learn more about PPH click here. For more information about
hemorrhoids click here.