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Benign Anorectal

Written and reviewed by
Dr. Sandip Banerjee 88% (146 ratings)
Fellowship in Minimal Access Surgery, MNAMS (Membership of the National Academy) (General Surgery) , FAIS, FACRSI, Fellowship in GI Surgery, DNB (General Surgery), MBBS
General Surgeon, Delhi  •  17 years experience
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Hello friends, I am Dr. Sandip Banerjee, and I am a consultant laparoscopic surgeon, bariatric and colorectal surgeon. I am practicing in my clinic, named as Pelvinic. I am also a head surgeon in Apollo Spectra Kailash Colony.

Today I am going to talk about benign anorectal conditions which are problems involving your anus and rectum, and which is involving a large amount of population in our country. So the primary problem arising out of this is because of a constipation. Constipation is affecting almost 13 % of the population, much higher than what diabetes and hypertension are affecting our population. So because of a constipation there are few problems which day in day out in the routine life, and involves any group, any class of patients.

The first thing I’m going to discuss is a fissure in anus. Fissure is a painful condition in anus which mostly is because of an ulcer formation, or the breach of skin in the anus which develops due to the passage of hard stool. And the main symptoms of this is a painful difficulty to sit, postural problems, and painful defecation, with a minimum association of passage of minimum amount of fresh amount of blood during defecation. The solution lies in the treatment with medical management mostly. And 70 to 80 percent of the patient benefit out of the medical management. Only the remaining of the patients who develop a chronic fissure, who are not being cured by medical management, they are the one fit for surgery.

The second one is in hemorrhoids, which are called piles. So all of us do have an anal cushions normally, and which once gets prolonged due to chronic straining developed pathological piles. Now, the piles were graded according to the size, and the type of problems which patients are facing. It can be graded from grade one to grade four. The initial grade piles, which are grade one and two, in which the patients do have problems related to like bleeding or mucous discharge or some sort of difficulty while passing stool. But there is no history or no complaints of something coming out of the anus. So they are the early grade piles. In early grade piles, either they need some sort of a treatment in terms of medicine, or at times when it is really bothersome, then we do advise some nonsurgical treatment like laser radiofrequency ablation, cryotherapy, and even banding. But for the haemorrhoids which are quite big, like grade three and four, in which the patients mainly complain of something coming out of the anus, and they need to manually reposition it. So, they are the one which needs a definitive surgery. And the surgery which has come late in a high success rate is the stapler surgery for haemorrhoids. The stapler surgery which has been used for last 10-15 years is seen with a lot of success, that has revolutionized the piles surgery, in which the patients only need a day in a hospital, goes back to home, without any pain, without any problems thereafter. The chances of recurrence even less than 0. 001%. Then there are some acute conditions in which you develop an abscess in the anus, and you must know that abscess in the anus should always be drained. It should always be surgically drained, and there is no other way just to linger it on with medication.

Because if an abscess in the anus or the perianal region is being neglected, that abscess may develop into a tract which is called a fistula, and once you have developed a fistula then it’s very difficult to treat. Now, fistula in anus is a tract which is connecting the outer skin with the inner anus. So what happens is that a patient, once they develop a fistula, they have typical complaints of persistent perianal discharge in forms of pus, and then suddenly the discharges end, and then patients are quite okay. For few days, the patient may develop some swelling, there is severe pain, and then sudden discharge again comes back. So in this way the cycles goes on and develops into a complex tract.

It’s very important to know what is the tract of a fistula. While treating fistula we see whether it’san high or a low fistula. So low fistula need not need any further imaging things, because out of experience we can find it out while doing proctological examinations that it’s a low fistula. Low fistula has a very high success rate of surgical cure. Whereas in high fistula it requires some sort of an MRI imaging. MRI imaging helps us to know the different kind of tracts, and once knowing the tracts we need to perform some different forms of surgery based on the tract. It can be a laser, it can be radio frequency ablation, it can be a vaaft surgery, it can be a lift surgery. Based on the complex nature of the fistula, the cure rate is quite. The cure rate is having a recurrence rate of 3-7% world over. And I have been using radio frequency ablation for different types of fistulas. Even laser has been applied, and I’ve met with a quite a good amount of success in my patients.

The other 2 things which I want to discuss is about rectal prolapse. Now the patients do complain of something coming out as a chunk through the anus while defecation, and it’s a quite a big amount as compared to hemorrhoids. Patients do have a problem associated with rectal prolapse, either they have chronic diarrhoea, or constipation. So it can be either constipated prolapse or a diarrheal prolapse, and for that too it needs a treatment, and definitive surgery. Definite treatment is a surgery, and it involves a laparoscopic cure from the abdomen. And the last is pilonidal sinus. And pilonidal sinus develops as a small chronic discharging fissure in between the anus…buttocks, and that also needs a very good flap surgery. So hope you will like this information, and for any type of solution, any type of cure, you can contact me either in Pelvinic, or through Lybrate, or in Apollo Spectra Kailash Colony. Thank you.

And the last is pilonidal sinus. And pilonidal sinus develops as a small chronic discharging fissure between the buttocks, and that also needs a very good flap surgery.

I hope you like this information, and for any type of solution or any type of cure, you can contact me either in Pelvinic, or through Lybrate, or in Apollo Spectra Kailash Colony. Thank you.

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