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Minimal access management of haemorrhoids (PPH)

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21/05/2007

Haemorrhoids or piles are swollen blood vessels in the anal canal (back passage). These blood vessels are part of our normal anatomy and play a role in keeping us continent; 1 in 3 people however go on to develop a problem with them at some stage of their life.




They are usually caused through constipation. Straining causes congestion of and eventually enlargement of the veins within the anal canal. They are more common during or after pregnancy. They can bleed, cause discomfort, a feeling of incomplete evacuation and may prolapse out of the anal canal causing a mucus discharge or soiling.
 
The traditional approach to haemorrrhoids is to excise them - a Millgan Morgan Haemorrhoidectomy (see below).  The operation has a reputation for pain and the wounds take 6-8 weeks to heal.










A minimally invasive approach PPH developed in Italy in 1997 was introduced into the UK almost 5 years ago. The technique allows patients to recover much faster from haemorrhoidal surgery and with less pain and fewer complications when compared to conventional excision surgery.  It is all very understandable when you see the final result (see below).  Bristol Laparoscopic Associates approach haemorrhoids almost exclusively using PPH.




PPH reduces/removes the prolapse, and in doing so pulls the haemorrhoids up into their normal position - a bit like a face lift.  It is used in secondary degree haemorrhoids when other measures eg repeated banding have failed and 3rd degree haemorrhoids (prolapse can be reduced manually). We have found it very useful in treating 4th degree (prolapsed out all the time) haemorrhoids.



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