What is MIPH/PPH?

MIPH (MINIMALLY INVASIVE PROCEDURE FOR HEMORRHOIDS) AKA PPH (PROCEDURE FOR PROLAPSE AND HEMORRHOIDS) AKA STAPLER HEMORRHOIDOPEXY What is MIPH/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.

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.

What are the Contraindications of Minimally Invasive Procedure for Hemorrhoid?

Complication of this surgery include: 1. Active sepsis, 2. Anal stenosis, and 3. Full-thickness rectal prolapsed Because these conditions are not adequately treated by PPH.

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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, 1.

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Incontinence, Anal stenosis, Fistula, and Septic complications.

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.

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.

ADVANTAGES OF MIPH/PPH: The Stapler procedure has definite advantages over other treatments available for Piles (Mulvyadh).

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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 5. Faster recovery - Patient can resume work from 5th day 6. Lowest recurrence rate ( 8% ) - This is further brought down to < 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: 1. Inflammation or Infection - Can be prevented with anti-inflammatory agents and antibiotics 2. Urgency (i.e. need to rush to the toilet) - May last for 4-8 weeks. This can be kept under control with Kegels exercises.

3. Bleeding following the procedure (6-8%) 4. Staple line stricture ( ~5% ) - In experienced hands it can be prevented with proper positioning of staple line 5. Recurrence ( 8% ) - With the addition of Mucopexy, this can be brought down to < 1%

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