Double PPH technique for hemorrhoidal prolapse: a multicentric, prospective, and nonrandomized trial

Area of Science:

• Colorectal Surgery
• Surgical Innovation
• Gastroenterology

Background:

• Longo's procedure (PPH) is a widely used hemorrhoid treatment with a 7.7% recurrence rate.
• Advanced hemorrhoidal prolapse may require more than a single stapling device for adequate resection.
• Recurrence after PPH can be linked to insufficient resection of prolapsed tissue.

Purpose of the Study:

• To describe and evaluate the Double PPH Technique (D-PPH) for treating large hemorrhoidal prolapses.
• To compare the safety and efficacy of D-PPH versus the standard single PPH.
• To assess the impact of D-PPH on postoperative complications and recurrence rates.

Main Methods:

• A multicentric, prospective, nonrandomized trial was conducted from July 2008 to July 2009.
• 281 patients with hemorrhoidal prolapse were divided into two groups: single PPH (n=207) and D-PPH (n=74).
• Outcomes measured included postoperative complications (bleeding, pain, urgency) and 12-month prolapse recurrence.

Main Results:

• Postoperative complication rates were similar between groups (5% for both).
• Specific complication rates: bleeding (3.0% PPH vs 4.1% D-PPH), pain (37.9% PPH vs 27.3% D-PPH), and urgency (2.1% PPH vs 5.7% D-PPH).
• 12-month recurrence rates were 3.7% for PPH and 5.9% for D-PPH, with no statistically significant difference.

Conclusions:

• The Double PPH Technique (D-PPH) is a safe and effective option for large hemorrhoidal prolapses.
• Accurate intraoperative patient selection for single (PPH) or double (D-PPH) stapling is crucial.
• Optimized patient selection may significantly reduce recurrence rates following Longo's procedure.