title: Redo procedure for prolapse and haemorrhoids (PPH) for persistent and recurrent prolapse after PPH.
abstract: OBJECTIVE
  Procedures for haemorrhoidal prolapse that maintain functional haemorrhoidal anatomy are progressively used. The procedure for prolapse and haemorrhoids (PPH) has advantages over conventional haemorrhoidectomy, but is associated with a higher recurrence rate. The feasibility and efficiency of a second PPH instead of haemorrhoidectomy in case of recurrent symptoms were studied.
  
  
  METHODS
  A retrospective chart review was conducted of all patients that were treated with PPH for haemorrhoidal prolapse in our hospital between May 2002 and November 2008. All patients in need for a second PPH because of persistent or recurrent symptoms of prolapse were identified and analyzed.
  
  
  RESULTS
  Out of 137 patients who underwent a PPH, 22 patients (16%) were in need of a reoperation for symptoms of prolapse. Of these, 12 (55%) were treated with a second PPH. Successful prolapse reduction was achieved in 11 out of 12 patients. No postoperative complications were encountered during a median follow-up of 35 months.
  
  
  CONCLUSIONS
  Redo PPH, in case of persisting or recurrent symptoms of haemorrhoidal prolapse after PPH, is feasible and is a good alternative for excisional haemorrhoidectomy. It possesses the same advantages over haemorrhoidectomy as the initial PPH and does not lead to more morbidity.
authors.affiliation: Department of Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands. s.festen @ olvg.nl
authors.forename: S
authors.initials: S
authors.lastname: Festen
authors.forename: A A W
authors.initials: AA
authors.lastname: van Geloven
authors.forename: M F
authors.initials: MF
authors.lastname: Gerhards
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005240:Feasibility Studies; D005260:Female; D006484:Hemorrhoids / Q000150:complications / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011391:Prolapse; D012005:Rectal Prolapse / Q000150:complications / Q000517:prevention & control / Q000601:surgery*; D012086:Reoperation / Q000379:methods; D012189:Retrospective Studies; D055502:Secondary Prevention; D016896:Treatment Outcome; D055815:Young Adult