Pictures of PPH purse string

Abscesses cannot be treated by antibiotics - instead, it needs to be located and drained.Stapled Hemorrhoidsopexy (PPH Procedure)

Also known as Procedure for Prolapse & Hemorrhoids (PPH), Stapled Hemorrhoidsectomy, and Circumferential Mucosectomy. 

PPH is a technique developed in the early 90's that reduces the prolapse of Hemorrhoids tissue by excising a band of the prolapsed anal mucosa membrane with the use of a circular stapling device. In PPH, the prolapsed tissue is pulled into a device that allows the excess tissue to be removed while the remaining Hemorrhoids tissue is stapled. This restores the Hemorrhoids tissue back to its original anatomical position. 

The introduction of the Circular Anal Dilator causes the reduction of the prolapse of the anal skin and parts of the anal mucous membrane. After removing the obturator, the prolapsed mucous membrane falls into the lumen of the dilator. 

The Purse-String Suture Anoscope is then introduced through the dilator.

This anoscope will push the mucous prolapse back against the rectal wall along a 270° circumference, while the mucous membrane that protrudes through the anoscope window can be easily contained in a suture that includes only the mucous membrane. By rotating the anoscope, it will be possible to complete a purse-string suture around the entire anal circumference.

The Hemorrhoids Circular Stapler is opened to its maximum position. Its head is introduced and positioned proximal to the purse-string, which is 
then tied with a closing knot.

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