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RECTAL SURGERY

Types of Surgery

ANORECTAL CONDITIONS

HEMORROIDS

What are hemorrhoids?

Hemorrhoids, also known as piles, are swollen and inflamed veins in the rectum and anus. They can occur internally, inside the rectum, or externally, under the skin around the anus.Hemorrhoids are a common condition and can develop due to various factors, including:

  • chronic constipation or diarrhea
  • straining during bowel movements
  • obesity
  • aging
  • pregnancy

 

Symptoms
  • Pain or discomfort, especially during bowel movements
  • Itching, irritation, or discomfort around the anus
  • Swelling or lumps around the anus
  • Rectal bleeding

Rectal bleeding, typically noticed as bright red blood on toilet paper or in the toilet bowl after a bowel movement,should alarm the patient

Diagnosis

Diagnosing hemorrhoids typically involves a combination of medical history, physical examination, and sometimes additional tests to rule out other conditions that may cause similar symptoms. The doctor may visually inspect the anal area for signs of external hemorrhoids, such as swelling, irritation, or lumps around the anus. In addition a digital rectal examination is performed (DRE). During a DRE, the doctor inserts a lubricated, gloved finger into the rectum to feel for internal hemorrhoids or other abnormalities. This helps assess the size, location, and severity of internal hemorrhoids. A colonoscopy may be recommended if there is concern about other gastrointestinal conditions, such as colorectal cancer or inflammatory bowel disease.

Treatment  

Treatment for hemorrhoids depends on the severity of symptoms and may include a combination of lifestyle changes, home remedies, over-the-counter medications, and medical procedures. The conservative treatment begins with topical application of over-the-counter creams, ointments, suppositories, or pads containing ingredients such as hydrocortisone or lidocaine which can relieve the pain, and inflammation associated with hemorrhoids. If the conservative treatment fails repeatedly, surgery is indicated 

Surgical treatment 

  • Laser hemorrhoidoplasty (LHP) is a minimally invasive surgical procedure used to treat hemorrhoids. It involves using laser energy to shrink and seal off the swollen blood vessels inside or around the anus that contribute to hemorrhoids
  • The laser precisely targets the hemorrhoidal tissue, causing minimal damage to the surrounding areas
  • Shorter hospital stay (6 hours).Many patients can go home the same day or after a short observation period.
  • Reduced pain,due to the smaller incisions, patients typically experience less postoperative pain compared to open surgery.
  • Recovery time is generally quicker, allowing patients to resume normal activities sooner
  • Lower risk of complications 

PΕRIANAL FISTULA

What is a perianal fistula?

A perianal fistula is a type of abnormal passageway or tunnel that forms between the skin near the anus and the inside of the anal canal. It usually develops as a result of an infection or inflammation in the anal glands, which are small glands near the anus that produce lubricating fluid.

Symptoms of breast cancer:

The symptoms associated with a perianal fistula are primarily caused by the underlying infection and inflammation, as well as the presence of the abnormal tract itself.The most common symptoms of a perianal fistula include:

  • Persistent drainage of pus or foul-smelling discharge from an opening near the anus.
  • Itching or irritation around the anal area.
  • Swelling or lumps near the anus - Abscess formation
  • Pain or discomfort around the anus, especially during bowel movements or when sitting.
Types of fistulas
  • Intersphincteric : This type of fistula begins in the anal canal and extends through the internal anal sphincter muscle into the intersphincteric space between the internal and external anal sphincter muscles.
  • Transsphincteric: the fistulas traverse both the internal and external anal sphincter muscles, extending from the anal canal through the intersphincteric space and into the perianal skin. They often present with multiple external openings and may be associated with a history of anal abscesses.
  • Suprasphincteric: Suprasphincteric fistulas start in the anal canal but take a more circuitous route, extending above the external anal sphincter muscle into the space between the external sphincter and the levator ani muscle in the pelvis.
  • Subcutaneous or submucosal : the fistula is located under the skin
Diagnosis

A physical examination of the anal area is typically performed to look for signs of a fistula, such as redness, swelling, or an external opening.(MRI) is considered the most accurate imaging modality for assessing perianal fistulas.

Treatment

The choice of surgical treatment depends on factors such as the fistula's location, complexity, underlying conditions (e.g., Crohn's disease), and patient preference.

  • Fistulectomy: In some cases, particularly when the fistula is associated with chronic infection or inflammation, the entire fistula tract may need to be surgically removed.
  • Seton Placement: A seton is a thin piece of material (e.g., silk thread, rubber band) that is passed through the fistula tract and left in place to promote drainage and prevent closure. This can be helpful in complex or recurrent fistulas.
  • Laser treatment is a relatively new approach that aims to offer a minimally invasive alternative to traditional surgical techniques. During the procedure, a laser fiber is inserted into the fistula tract under guidance, typically using an endoscope or other imaging technology. The laser energy is then applied to the walls of the fistula tract, causing tissue destruction or sealing of the tract. Advantages: • Minimally Invasive • Reduced Risk of Sphincter Damage: Laser treatment may be associated with a lower risk of damage to the anal sphincter muscles compared to traditional surgery, potentially reducing the risk of fecal incontinence. • Faster Recovery: Since laser treatment is minimally invasive, it may result in faster recovery times and less postoperative pain compared to traditional surgery.

3.PERIANAL ABSCESS

What is a perianal abscess?

A perianal abscess is a painful collection of pus near the anus. It's often caused by an infection in the small glands around the anus.

Symptoms of breast cancer:

As the abscess increases in size, it may cause the following symptoms:

  • Pain around the anus which can worsen with movement or sitting.
  • Fever can develop if the infection is severe
  • Difficulty with Bowel Movements
  • Fatigue – malaise
  • Pus or Fluid Drainage
Treatment

The primary treatment for a perianal abscess is incision and drainage (I&D). This procedure involves making a small incision in the abscess to allow the pus to drain out. It's usually done under local anesthesia to minimize pain. In some cases, especially if the infection is severe, has spread beyond the abscess site, or if there are signs of systemic infection (such as fever), antibiotics may be prescribed.

Pain management is an essential aspect of treatment. Over-the-counter pain relievers such as ibuprofen or acetaminophen may help alleviate discomfort Taking warm sitz baths several times a day can help soothe the area, promote healing, and reduce discomfort. A sitz bath involves sitting in a few inches of warm water for about 10-15 minutes at a time.

After drainage, it's essential for regular follow up for wound care and to monitor for any signs of complications such as recurrence or the development of a fistula.

4.PILONIDAL CYST/SINUS

What is a pilonidal cyst?

A pilonidal cyst is a small sac or pocket that forms in the skin at the top of the cleft of the buttocks. It usually contains hair, skin debris, and sometimes pus.Common causes and contributing factors include:

  • Ingrown hairs: The most frequent cause, where hair penetrates the skin and causes irritation and infection.
  • Repeated friction or trauma to the area, often from tight clothing or activities that involve significant movement in the buttocks region.
  • Extended periods of sitting, which puts pressure on the coccyx (tailbone)
 

Hairs from the scalp, back, or buttocks get trapped in the buttock cleft. These hairs can then penetrate the skin, leading to irritation and an inflammatory response.

Symptoms :

  • Pain near the tailbone (coccyx), or in the cleft of the buttocks
  • Itching
  • Blood discharge
  • Fluid discharge
 

Complications

In some cases, pilonidal cysts can lead to the formation of sinus tracts or abscesses, which are small tunnels or pockets of infection beneath the skin. The following symptoms maybe present :

  • Increased pain
  • Redness of the skin over the cyst
  • Pus discharge
  • Fatigue – malaise
  • Fever
 

Diagnosis :

Diagnosing a pilonidal cyst typically involves a combination of medical history, physical examination, and sometimes imaging studies.MRI may be ordered to evaluate the extent and characteristics of the cyst, especially if it's deep or if there are concerns about complications such as sinus tracts or abscesses.

Treatment
  • Incision and Drainage (I&D):it is recommended in cases of cyst inflammation and abscess formation. This procedure involves making a small incision in the cyst to drain pus and relieve pressure. It's typically done under local anesthesia to minimize pain.
  • Excision with Primary Closure:involves surgically removing the entire cyst and any surrounding tissue, followed by closing the wound with stitches (primary closure). This approach aims to remove the source of the problem while promoting faster healing and minimizing the risk of recurrence.
 

Benefits:

  1. Reduced wound care: there is typically less need for extensive wound care, such as frequent dressing changes.
  2. Less pain and discomfort during the recovery period.
  3. Primary closure often results in a more aesthetically pleasing outcome with less scarring
 
  • Laser ablation may be used as an alternative to traditional surgical techniques for pilonidal cysts. This minimally invasive procedure uses laser energy to destroy the cyst and promote healing. They may be particularly suitable for smaller cysts or those located in sensitive areas.
Benefits:
  1. Minimally invasive procedure that typically involves smaller incisions and less tissue disruption compared to traditional surgical techniques.
  2. Reduced bleeding
  3. Less postoperative discomfort
  4. Recovery time is generally quicker, allowing patients to resume normal activities sooner
  5. Lower risk of infection,reduced scarring

5.ANAL FISSURE

What is an anal fissure?

An anal fissure is a tear or split in the lining of the anus, the opening at the end of the digestive tract through which stool exits the body. Anal fissures can be uncomfortable and may affect quality of life, but with proper diagnosis and treatment, most fissures heal within a few weeks.

Anal fissures can be caused by various factors, including passing hard or large stools, chronic diarrhea, or constipation, straining during bowel movements, childbirth, anal trauma, or inflammatory bowel disease. The tear in the lining of the anus exposes sensitive underlying tissue, leading to pain and discomfort.

If conservative measures fail to provide relief or if the fissure is chronic or severe, surgical intervention may be necessary.

Symptoms:

  • Pain during or after bowel movements
  • Bleeding
  • Itching or irritation
  • Spasm of the anal sphincter
  • Foul smelling fluid discharge from the anus
  • Visible tear or crack
 

Diagnosis

The diagnosis is made by examining the affected area in combination with the symptoms.

  • Treatment :

Acute anal fissure:

In the acute phase, treatment is conservative with the local application of creams or ointments such as:

  • Numbing creams or ointments
  • Nitroglycerin ointment
  • Suppositories
 

Also is recommended :

  • Staying hydrated
  • Increased fiber intake
  • Taking stool softeners
  • Sitz baths
 

Chronic anal fissure:

If after 6 to 8 weeks conservative treatment is not effective, surgical intervention is recommended.Surgical options may include:

  • Laser treatment of anal fissures: is a minimally invasive procedure that uses laser energy to treat anal fissures.Advantages:
 
  • Does not require incisions or sutures
  • High success rate (90%)
  • Laser energy can be precisely targeted to the affected area, allowing for precise cutting and minimal damage to surrounding tissue,reducing risk of sphincter damage
 

Laser treatment for anal fissures is usually performed on an outpatient basis, meaning patients can go home the same day.

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The material of this website is informative,by anymeans it has no purpose on replacing medical examination,diagnosis and treatment for any condition that is described

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