Minimally Invasive surgery for piles.

Dr Antonio Longo, http://www.icds-hk.org/longo.html was the one who pioneered and revolutionised piles surgery in 1993. More than 2,00,000 MIPH have been performed worldwide since.
 It is based on the principle that piles is caused by mucosal prolapse and thus aims to correct it by removing a strip of rectal mucosa alongwith submucosa and anastomosing the two ends. It is claimed that this corrects the anatomical abnormality and interrupts the blood supply to the pile mass running through submucosa thus achieving shrinkage of the pile mass post-op. Complete shrinkage of piles is achieved over 2-3 months.
This procedure has been recommended as first line treatment for 3rd, 4th degree piles by National Institute of Clinical Excellence (NICE) 2007.
 Commonest complications of this procedure are: bleeding, stenosis(10%), recurrence(2-5%). To prevent stenosis it is therefore recommended to use anal dilator gently by the patient twice daily for atleast three months starting from 10th post-op day.


Advantages of this procedure over conventional surgery:

• Less or no post-op pain.
• Early return to activity. Patient is discharged in 1-2 days normally.

This procedure is to be done accurately and results are good. Presenting few pictures of MIPH.

Pre-op 3rd degree piles.

Insertion of stapler.

Check donut.

Finished Stapled line.