Procedure for Prolase and Hemorroids

Recently, an alternative technique has been developed and tested that is associated with markedly reduced postoperative pain (Sutherland et al, 2002). The procedure for prolapse and hemorrhoids (PPH), or stapled hemorrhoidectomy, employs a circular stapler with a hollow head to excise a cuff of tissue at the most superior aspect of hemorrhoidal complexes and create a superficial end-to-end anastomosis (Figure 92-2). During this procedure, a submucosal purses-tring is placed 4 cm above the dentate line and is secured to the post of the anvil of the stapler. The excess tissue is pulled into the hollow head of the stapler as the stapler is closed. As the stapler is fired, a circumferential cuff of tissue is excised, and the superficial anastomosis is created. In effect an anopexy is performed which lifts the prolapsed tissue into the anal canal. Randomized trials have reported significantly lower pain scores when compared to conventional hemor-rhoidectomy procedures. Although higher instrument costs may deter widespread acceptance of the PPH, less pain, a shorter convalescence, and earlier return to normal activity should be considered in the choice of surgical therapy.

Horribles HemorrhoidsCosa Instrument Liver

FIGURE 92-2. Fourth degree (irreducible) hemorrhoids before (A) and immediately after (B) procedure for prolaspe and hemorrhoids (PPH) has been performed. Circumferential specimen of mucosa and submu-cosa excised with the PPH stapler (C).

Constipation Prescription

Constipation Prescription

Did you ever think feeling angry and irritable could be a symptom of constipation? A horrible fullness and pressing sharp pains against the bladders can’t help but affect your mood. Sometimes you just want everyone to leave you alone and sleep to escape the pain. It is virtually impossible to be constipated and keep a sunny disposition. Follow the steps in this guide to alleviate constipation and lead a happier healthy life.

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