Merits and Demerits of PPH (Procedure for Prolapse and Hemorrhoids) in Comparison with LE (Ligation and Excision) and ALTA Therapy

Abstract

The procedure for prolapse and hemorrhoids (PPH), which was first described by Longo in 1998, reduces the prolapse of hemorrhoidal tissue by excising a band of the prolapsed anal mucosa membrane by using a circular stapling device. This technique has rapidly spread all over the world because it is associated with less pain and better quality of life postoperatively. In Japan, since 2001 it has been successfully introduced in the management of third-degree hemorrhoids, and has been reported to be associated with less postoperative pain, rapid recovery and low recurrence rate. The incidence of postoperative complications has been reduced with advances in stapling devices and techniques. However, PPH is not indicated for all types of hemorrhoids, and should be used selectively under strict indications. Therefore, it should be performed by skilled and experienced surgeons who are familiar with not only this technique but also other treatments such as ligation and excision (LE) and ALTA. From our experience, PPH is a highly effective treatment for selected patients with hemorrhoids.