title: Double PPH technique for hemorrhoidal prolapse: a multicentric, prospective, and nonrandomized trial.
abstract: BACKGROUND
  Longo's technique (or PPH technique) is well known worldwide. Meta-analysis suggests that the failure due to persistence or recurrence is close to 7.7%. One of the reasons for the recurrence is the treatment of the advanced hemorrhoidal prolapse with a single stapling device, which is not enough to resect the appropriate amount of prolapse.
  
  
  METHODS
  We describe the application of "Double PPH Technique" (D-PPH) to treat large hemorrhoidal prolapses. We performed a multicentric, prospective, and nonrandomized trial from July 2008 to July 2009, wherein 2 groups of patients with prolapse and hemorrhoids were treated with a single PPH or a D-PPH. Results were compared. The primary outcome was evaluation of safety and efficacy of the D-PPH procedure in selected patients with large hemorrhoidal prolapse.
  
  
  RESULTS
  In all, 281 consecutive patients suffering from hemorrhoidal prolapse underwent surgery, of whom 74 were assigned intraoperatively to D-PPH, whereas 207 underwent single PPH. Postoperative complications were 5% in both groups (P = .32), in particular: postoperative major bleeding 3.0% in PPH versus 4.1% D-PPH (P = .59); pain 37.9 % PPH versus 27.3% D-PPH (mean visual analog scale [VAS] = 2.5 vs 2.9, respectively; P = .72); and fecal urgency 2.1% PPH versus 5.7% D-PPH (P = .8). Persistence of hemorrhoidal prolapse at 12-month follow-up was 3.7% in the PPH group versus 5.9% in the D-PPH group (P = .5).
  
  
  CONCLUSIONS
  Our data support the hypothesis that an accurate intraoperative patient selection for single (PPH) or double (D-PPH) stapled technique will lower in a significant way the incidence of recurrence after Longo's procedure for hemorrhoidal prolapse.
authors: 1U.O. Chirurgia 2, Az. Ospedaliera S. Maria degli Angeli, Pordenone, Italy.
authors: A
authors: A
authors: Braini
authors: P
authors: P
authors: Narisetty
authors: A
authors: A
authors: Favero
authors: S
authors: S
authors: Calandra
authors: A
authors: A
authors: Calandra
authors: F
authors: F
authors: Caponnetto
authors: F
authors: F
authors: Digito
authors: F
authors: F
authors: Da Pozzo
authors: E
authors: E
authors: Marcotti
authors: E
authors: E
authors: Porebski
authors: S
authors: S
authors: Rovedo
authors: G
authors: G
authors: Terrosu
authors: L
authors: L
authors: Torricelli
authors: A
authors: A
authors: Stuto
mesh_terms: D000328:Adult; D000368:Aged; D013505:Digestive System Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006484:Hemorrhoids / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000209:etiology; D019106:Postoperative Hemorrhage / Q000209:etiology; D011446:Prospective Studies; D012005:Rectal Prolapse / Q000601:surgery*; D055815:Young Adult
keywords: D-PPH; hemorrhoids; mucohemorrhoidal prolapse; prolapse