Anorectal Surgery

An anal fistula, widely known as fistula-in-ano, is nothing but a small channel that develops between the end of the rectum and the skin near the anus. It can cause extreme pain and bleeding while passing stools.

• Causes: The injury caused to the skin at the anal opening because of a hard and dry bowel movement, is considered as the most common cause of Anal Fistula. Other causes are Digital insertion that may happen during anus examination, foreign body insertion or having an anal intercourse. Pregnant women are also prone to develop an anal fistula during childbirth.
• Treatment: To treat anal fistula, our expert surgeons perform a surgery to assess the depth as well as the extent of fistula tract. The following procedures of surgery are used globally:
  • Minimally Invasive Fistula Treatment (MAFT)
  • Fistulotomy/Fistulectomy

Piles are also known as haemorrhoids. Hemorrhoids are nothing but the masses, cushions, or clumps of tissue developed in the rectum which are full of blood vessels, elastic fibers, support tissue, and muscle. Piles are categorized as Internal and External.

• Causes: Piles can develop due to prolonged constipation which leads to excessive straining that results in the swelling of veins near the rectal area.
• Treatment: The physical examination as well as proctoscopy must be carried out to diagnose piles. However, the right treatment at the right time can essentially reduce the itching as well as the discomfort experienced by many patients. The following treatment options are available:
  • Diagnosis: Depending upon the diagnosis done, the doctor will advise you if you require the home treatment or further advanced assistance.
  • Surgery: Surgery is only used for specifically large piles. Usually, surgery is considered as advanced treatment and is only used when the conservative or non-surgical treatment is not effective.

The fissure is caused by a small tear in the skin near the opening of anus. Fissures are usually developed by the hard, dry or painful bowel movements which can cause extreme pain or bleeding.

• Causes: The injury caused to the skin at the anal opening because of a hard and dry bowel movement, is considered as the most common cause of Anal fissures. Other causes are Digital insertion that may happen during anus examination, foreign body insertion or having an anal intercourse. Pregnant women are also prone to develop a fissure during childbirth.
• Treatment: Anal fissures may take few weeks to heal completely, only if you follow the precautionary steps to keep your stool soft.
  • Conservative management : Around 50% of the anal fissures can be treated and healed by the medical management including the topical ointments, warm water bath, dietary modifications, and drinking water, juices or other edible fluids in abundance.
  • Surgery: Surgery is only performed when the fissures don’t respond to other medical treatment. In this case, the following two surgical options are open to be performed:
    • Chemical Internal Sphincterotomy: it is a least painful approach as the treatment that relaxes the anal muscles by injecting chemicals inside the anal sphincter muscle which acts as a local anesthesia and partially paralyzes it.
    • Lateral Internal Sphincterotomy: This surgical method is used to divide a portion of the anal sphincter muscle which eventually helps the fissure to heal and reduce the the pain. It is considered as the most effective treatment for the non-healing fissures.

A rectal prolapse only occurs when the rectum bulges out of the anal opening because of the stretching or disruption of its attachments with the abdominal wall.

• Causes: The exact cause of Prolapse still remains unclear. However, the following factors can be considered as the causes:
  • Extensive straining during the bowel movements,
  • Multiple pregnancies,
  • Neurological illnesses causing connective tissue disorders or muscular weakness
  • Weakening of the anal sphincter muscle is usually linked with the rectal prolapse which results in the leakage of stool as well as the mucus discharge.
• Treatment: The Prolapse treatment is completely dependent on the history of the patient’s symptoms as well as the physical examination. Defecography is required to treat the internal rectal prolapse. Several surgical methods are available to repair the prolapse.
  • Rectal (perineal) Repair Approaches
    • • Minimally Invasive Procedure for Hemorrhoids (MIPH)
      • Altemeier procedure (widely known as a proctosigmoidectomy)
      • Thiersch wiring
    The perineal approach is considered as the least painful method that has the following benefits:
    • Reduced operative time
    • Less blood loss
    • Faster recovery
    • Less postoperative pain
  • Abdominal repair approaches: Abdominal procedure is carried out by making an incision in the abdomen and operating inside the abdominal cavity. This surgical method is only performed under the general anesthesia. The two typical abdominal surgical methods are:
    • Rectopexy
    • Resection