SMDP participants take part in a six-week Management for International Public Health (MIPH
) course that trains managers from developing countries in the basic management skills of planning, priority setting, problem solving, budgeting, and supervision.
Third and fourth degree always require surgical treatment like haemorrhoidectomy which can be open, (2) closed (3) or submucosal haemorrhoidectomy of park or stapled haemorrhoidopexy (MIPH).
MIPH (Minimally Invasive Procedure for Haemorrhoid or Stapled Haemorrhoidopexy) was first described by on Italian surgeon.
In MIPH technique neither the anal mucosa nor the haemorrhoidal tissue is excised.
Minimally Invasive Procedure for Haemorrhoid (MIPH) were performed in duration of 11-20 minutes in 2 (8%) patients, 21-30 minutes in 13(52%) patients, 31-40 minutes in 7 (28%) patients and 41-50 minutes in 3 (12%) patients.
All patients were offered Management of Haemorrhoids Using Minimally Invasive Procedure for Haemorrhoid (MIPH) and studied for the outcome of the procedure.
As far as early complications occurred after MIPH in our study, twelve percent patients developed bleeding which was intra-operative.
Seventy two percent patients became ambulatory within 6-12 hours after MIPH surgery.
Longest hospital stay in this study was 9 days in which patient had prolapsed external pile and skin tag after MIPH, which was ligated and skin tag excising in next operation day sitting after 7 days of MIPH surgery.
In our series urinary Retention was seen in 20 % patients after MIPH. In studies related to this rates between 0.3 and 20% were reported.