What is MIPH And PPH

1
What is MIPH and PPH

• It is a procedure that was originally conceived
  in 1994 by Dr Antonio Longo, and since,has gained
  popularity as the treatment of choice for Grade 3
  and Grade 4 prolapsed Piles.( stapler image)
  Haemorrhoidal Stapler PPH03, a disposable device
  (Ethicon, Johnson Johnson, USA)The procedure is
  usually done under short general anesthesia and
  takes around 25-30 minutes. Using the circular
  stapler, the mucosa which is responsible for the
  the prolapse of Hemorrhoids is circumferentially
  excised and the prolapsed Hemorrhoids are pulled
  up back to their normal position.

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2

• How it work and what are the benefits of Stapled
  Hemorrhoidopexy ?
• Stapled  Hemorrhoidopexy  procedure uses a
  special device to remove a ring of tissue from
  the anal canal. Removing the tissue cuts off
  blood supply to the hemorrhoids, causing them to
  shrink. The tissue ring is then secured with
  staples. This helps hold the tissue in place.
  Stapled hemorrhoidopexy is a significantly less
  painful operation and offers significant
  advantages in terms of hospital stay and symptom
  control in the long term, making for a
  significantly earlier return to work.

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3
What are the Contraindications of Minimally
Invasive Procedure for Hemorrhoid? Complication
of this surgery include

• Active sepsis,
• Anal stenosis, and
• Full-thickness rectal prolapsed

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4
What are the complications of Stapled
Hemorrhoidectomy?

• Although PPH is usually considered relatively
  safe and simple, complications still may occur
  and sometimes may be devastating.
• Most common complication are
• Hemorrhage,
• Incontinence,
• Anal stenosis,
• Fistula, and
• Septic complications.

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5
What are the complications of Stapled
Hemorrhoidectomy?

• Possible complications of Minimally Invasive
  Procedure for Haemorrhoid (MIPH) include anal
  stenosis, postoperative pain, urinary retention,
  secondary hemorrhage, anal fissure, abscess or
  fistula, formation of skin tags, pseudo polyps,
  and incontinence. Postoperative pain is a main
  concern after Minimally Invasive Procedure for
  Haemorrhoid (MIPH) none of the techniques offers
  the patient a completely pain-free recovery.
  Urinary retention can be a result of pain in some
  of the patient, narcotics and anticholinergic
  drugs, fluid overload, high ligation of the
  hemorrhoidal pedicle and operative trauma.

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What are the complications of Stapled
Hemorrhoidectomy?

• Minimally Invasive Procedure for Haemorrhoid
  (MIPH), serious complications have been reported
  and include, rectal perforation, retroperitoneal
  sepsis, retropneumoperitoneum, rectal stricture,
  rectal obstruction, and rectovaginal fistula.
  These benefits may appear only after surgeons
  have gained sufficient experience with the
  procedure. However, skin tags and recurrent
  prolapse occurred at higher rates after PPH. The
  meta analysis did not find significant difference
  in the rates of postoperative bleeding, urinary
  retention, anal fissure, stenosis, or
  difficulties in evacuation.

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7
ADVANTAGES OF MIPH/PPH

• The Stapler procedure has definite advantages
  over other treatments available for Piles
  (Mulvyadh).
• No external cuts/stitches
• Minimal blood loss
• Minimal pain easily managed by painkillers
• Sphincter function is not hampered hence
  voluntary control over motion is preserved
• Faster recovery - Patient can resume work from
  5th day
• Lowest recurrence rate ( 8 ) - This is further
  brought down to lt 1 by Mucopexy technique
  introduced by Dr Porwal at Indiapiles

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POTENTIAL DRAWBACKS

• As with any surgical procedure there are possible
  drawbacks associated with MIPH
• Inflammation or Infection - Can be prevented with
  anti-inflammatory agents and antibiotics
• Urgency (i.e. need to rush to the toilet) - May
  last for 4-8 weeks. This can be kept under
  control with Kegels exercises.
•  Bleeding following the procedure (6-8)
• Staple line stricture ( 5 ) - In experienced
  hands it can be prevented with proper positioning
  of staple line
• Recurrence ( 8 ) - With the addition of
  Mucopexy, this can be brought down to lt 1

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9
Contact Us

• Mangalmurti Complex, 105,First floor, Near
  Hirabaug,Tilak Road,Pune - 411002Tel[phone]
  

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