Piles, Anal Fissures and Anal Fistula Surgery
Hemorrhoids or Piles
Hemorrhoids or Piles
Rubber Band Ligation
What are hemorrhoids or Piles?
Hemorrhoids - represent dilatation of veins in this area (anus and rectum) and surrounding tissues. They are similar to varicose veins that may appear on the lower limbs.
Hemorrhoids or piles involve two different vascular structures: the external hemorrhoidal plexus and the internal hemorrhoidal plexus.
Thus, hemorrhoids or piles can be internal (inside the anus) or external (around the anus).
- Constipation or diarrhea
- Sedentary life
- Premenstrual phase, pregnancy, childbirth
- Certain sports: horse riding, cycling
- Spicy diet, alcohol consumption
Signs and symptoms in hemorrhoidal or piles disease
External haemorrhoids or piles are visible around the anus. The internal haemorrhoids or piles are not visible outside and are seen only during Proctoscopy.
The hemorrhoidal disease can be asymptomatic or with discrete symptomatology (itching, irritation, discomfort, sero-mucopurulent secretions). It can be clinically translated into three types of signs that are already complications of the disease:
- Lumpy feel at the anal level
When you don't treat piles, complications can occur.
Without treatment may occur a
- chronic anaemia due to blood loss
- both internal and external haemorrhoids or piles may thrombose, causing severe pain.
Stages of Piles Formation
Hemorrhoids or piles that do not externalize
Hemorrhoids or piles that externalize on straining . They spontaneously go inside the anus.
Hemorrhoids or piles that externalize on straining (sneezing, coughing, defecation) . They need to be pushed inside manually.
Internal hemorrhoids or piles, which are not reduced inside the anus. They remain outside permanently
Anal Fistula Surgery
An anal fistula is an abnormal connection between the inside of your anal canal (back passage) and the skin around your anus.
Most anal fistulas are caused by an abscess (a collection of pus) ..The abscess develops in your anal canal. The pus can drain away onto the skin on its own or by an operation. A fistula happens when pus drains outside without surgery.
What are the benefits of anal fistula surgery?
If the operation is successful, you should no longer have any infection or pain.
Are there any alternatives to Fistula surgery?
Most anal fistulas do not heal on their own. Surgery is usually needed to treat the problem. Anal mucosal LIFT procedure is a new technique for fistula surgery
What happens during anal fistula surgery?
Surgery for anal fistula is usually performed under a general or regional anaesthetic. The operation usually takes between a quarter of an hour and half an hour.
To lessen the risk of bowel incontinence (when you pass a motion without wanting to) your treatment may involve several operations over a number of months. The type of surgery you need will depend on where and the type of fistula .
- If the fistula is below or crosses the lower part of the sphincter muscles, your surgeon will cut it open to the skin and leave the wound open so that it can heal with healthy tissue.
- If the fistula has branches that pass through the upper part of the sphincter muscles, your surgeon may place a special stitch (called a seton stitch) in the fistula to allow pus to drain easily. Your surgeon will not need to make a cut in the skin or the sphincter muscle.
- If the fistula reaches above your sphincter muscles, you may need to have a temporary colostomy (bowel opening onto the skin). However, this is not common.
What complications can happen?
General complications of any operation:
- Unsightly scarring
Specific complications of this operation:
- Difficulty in passing urine.
- Involuntarily passing wind or loose faeces (Bowel incontinence)
How soon will I recover from this surgery?
You should be able to go home after 1-3 days. You should rest for the first few days, walking as little as possible, to help the wound to heal. The wound often takes several weeks to heal completely and you may need to wear a pad until then. Regular exercise should help you to return to normal activities as soon as possible. Before you start exercising, you should ask your doctor for advice. In a small number of cases, the fistula can come back.
Anal fistula surgery summary
An anal fistula can cause continued infection and pain. Symptoms usually get worse without an operation.
Pilonidal Sinus Surgery
What is pilonidal sinus surgery?
A pilonidal sinus is an infection and is almost always located in the natal cleft (between the buttocks). It is caused by ingrown hairs. It may present as an abscess that requires drainage. It can also be a more chronic, draining opening that is associated with pain and swelling.
How does the operation proceed?
During surgery, the abnormal skin/fat is usually removed along with the sinus. The resulting hole may be left open and closed with a dressing, closed with a simple suture, or closed with a 'flap' of nearby tissue.
What are the benefits of pilonidal sinus surgery?
The benefit of surgery is to remove the sinus and the associated leakage, pain and infection. In milder cases, the infection can sometimes be 'treated' (not cured) with antibiotics.
Are there any risks?
The risks of surgery are primarily infection and failure of the wound to heal. This may result in the need to renew dressings over a long period of time or the need for further surgery, which is bothersome but rarely serious. There is also a risk that the sinus will recur.
Your attending physician will discuss all risks with you in detail prior to surgery.