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Please wait loading VIdeo Lecture of Prof. R.K. Mishra about Safe PPH Surgery

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The typical morphological situation from the hemorrhoidal and mucous prolapse is caused by weakening and breakage of the supporting muscular and connective fibers. Prolapse implies the distal dislocation of the internal hemorrhoidal cushions that push the external hemorrhoidal sacs within an outward and lateral direction, thus causing the sacs to protrude.

The upper hemorrhoidal vessels extend, while the middle minimizing hemorrhoidal vessels are susceptible to the formation of kinks. The hemorrhoidal volume may remain normal or swell because of phlebostasis. It may also regress towards atrophy. In IV degree prolapse, the dentate lines are positioned almost outside the anal canal, and the rectal mucous membrane permanently occupies the muscular anal canal.

PPH is really a technique coded in the first 90's that cuts down on the prolapse of hemorrhoidal tissue by excising a band of the prolapsed anal mucosa membrane by using a circular stapling device. In PPH, the prolapsed tissue is pulled right into a device which allows the excess tissue to be removed as the remaining hemorrhoidal tissue is stapled. This restores the hemorrhoidal tissue to its original anatomical position. The development of the Circular Anal Dilator causes the decrease in the prolapse from the anal skin and parts of the anal mucous membrane. After removing the obturator, the prolapsed mucous membrane falls into the lumen from the dilator.