Why is stapled hemorrhoidopexy called PPH (Procedure for Prolapse and Hemorrhoids)?

Why Stapled Hemorrhoidopexy is Called PPH

PPH stands for "Procedure for Prolapse and Hemorrhoids," which directly describes the dual mechanism of this surgical technique: it addresses both the prolapsing hemorrhoidal tissue and the hemorrhoidal disease itself by resuspending prolapsed tissue and interrupting arterial blood flow. 1

The Name Reflects the Procedural Mechanism

• The acronym PPH was coined when Antonio Longo introduced this technique in 1998, specifically naming it to emphasize that the procedure treats both the prolapse component and the hemorrhoidal pathology simultaneously 1

• Unlike traditional hemorrhoidectomy which directly excises hemorrhoidal tissue, PPH removes a ring of redundant rectal mucosa above the anal canal using a modified circular stapling device, thereby lifting and repositioning prolapsed tissue back within the anal canal rather than cutting it out 1

• The procedure interrupts arterial inflow through the excised mucosal segment, which reduces blood supply to the hemorrhoidal cushions without removing the hemorrhoids themselves 1

Clinical Context of the Terminology

• The name distinguishes this approach from conventional hemorrhoidectomy by highlighting that it is fundamentally a repositioning procedure rather than an excisional one 1

• Patients must understand from the name itself that external hemorrhoids and skin tags will not be addressed, as PPH only treats internal prolapsing disease 1, 2

• The terminology has been maintained across multiple device iterations (PPH01, PPH03) and is used interchangeably with "stapled hemorrhoidopexy" in the medical literature 3, 4, 5, 6

Common Pitfall in Understanding

• The name can mislead patients into thinking all hemorrhoidal disease will be treated, when in reality only internal prolapsing components are addressed—external disease requires conventional hemorrhoidectomy if significant 1, 2