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Colorectal Surgery

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The Colorectal Surgery unit at Paideia International Hospital treats diseases of the colorectum and anus. Often patients are referred to the proctologist for disorders involving bleeding from the anorectum due to haemorrhoidal disease, which is in turn caused by recto-anal haemorrhoidal prolapse. Incontinence, evacuation disorders, rectum prolapse and obstipation (or constipation) are also treated by the proctologist.

Conditions treated at the Paideia International Hospital Colorectal Surgery unit

The main anorectal conditions:

The main colorectal conditions:

Diagnostic examinations:

Haemorrhoids

Haemorrhoids are bulges made up of arteries and veins located in the anal canal, and held in place by ligaments that help maintain fluid continence. These are referred to as haemorrhoidal disease when, for evacuation-related or acquired reasons, these bulges are not longer supported by the ligaments, i.e. they prolapse. Haemorrhoidal disease may be internal or external.

There are four stages of the disease: the first is the mildest, the fourth is manifested as a permanent prolapse with a burning sensation, bleeding and mucus discharge.

Causes and risk factors: family history, constipation, lifestyle, a diet low in fibre and water, obesity, a sedentary lifestyle and the type of work that forces a person to sit for long hours.

The symptoms are pain, burning sensation, bleeding with bright red blood loss and subsequent anaemia.

Treatment: each stage of haemorrhoidal disease has an appropriate treatment.

Ligasure, radiofrequency scalpel

The radiofrequency scalpel used for treating haemorrhoidal disease was designed with the aim of improving tissue synthesis while working at a low operating temperature, thus resulting in reduced tissue necrosis and reduced oedema of the surrounding tissues and consequently less post-operative pain.

It ensures perfect haemostasis, improves the ability to work in tight spaces and optimises the view of the surgical field. More than 1,000 patients have been ytreates surgically at Paideia International, achieving excellent results in terms of reduced post-operative painfaster wound healing and a rapid return to work.

Anal fissure

Anal fissure is an ulcer of the canal that can be acute or chronic. Causes include repeated mechanical stress such as hard stools as a consequence of constipation, inflammatory diseases (Crohn’s disease – ulcerative colitis), chronic diarrhoea, trauma, childbirth.

Symptoms: very severe pain during and after evacuation that may last for several hours afterwards, the presence of bright red blood in faeces or on the toilet paper, itching, pruritus ani, tearing of the skin around the anus.

Diagnosis: this is done by a simple inspection of the anus.

Anoscopyanorectal manometrycolonoscopy in case an inflammatory bowel disease is suspected.

Improving evacuation by improving constipation or diarrhoea certainly prevents anal fissures.

Treatment: improving diet by adding more fibre and water, cleansing with lukewarm sitz baths 2, 3 times a day. Applying low-dose nitroglycerin-based creams that act at the sphincter level, improving muscle relaxation, facilitates blood flow which helps healing. Applying anaesthetic creams or botulinum toxin that paralyses the anal sphincter muscle and stops spasms.

Surgery:internal lateral anal sphincterotomy is considered the gold standard for resolving the problem if other treatments fail. It involves cutting away a small portion of the internal anal sphincter and thus resolving the issue.

Perianal fistula

It often starts as a perianal abscess that later develops into a fistula. A fistula is an abnormal passageway between the anal canal and the perianal skin, i.e. a small tunnel connecting a diseased gland in the anal canal with the perianal skin.

The causes are obstructions of the anal glands and the subsequent formation of anal abscesses

Symptoms include pain and swelling in the anus, discharge of pus from a perianal orifice and fever.

Diagnosis is achieved by a specialist proctological examination and anoscopy: instrumental examinations include transrectal ultrasound with a rotating probe, and perianal pelvis MRI.

Fistula types: they can be simple or complex. Superficial, intersphincteric, transphincteric, suprasphincteric, extrasphincteric, depending on the relationship with the anal sphincter muscles.

Surgical treatment: fistula treatment is only surgical and there are no conservative methods. The infectious cause must be removed while preserving anal continence. Surgery requires comprehensive knowledge of the anatomy of the anal sphincters in order to avoid injury that may cause bowel incontinence. To this end, there are several surgical options to treat fistulas while preserving continence. So the most suitable method must be applied in each case. The most commonly used methods include fistulotomy, i.e. flattening the fistula; when sphincters are involved, it is standard practice to first place a seton for at least a week in order to drain the infection.

There are other methods that use mobilising a mucosal flap to close the internal fistulous orifice, a method called LIFT that involves cutting off the passageway of the fistula in the intersphincteric tract, video-assisted fistulotomy (VAFT), closure by laser or fibrin glue.

Sacrococcygeal fistula

This is a sac containing hair located on the sacrococcygeal region and affects people with a lot of body hair (hirsute). They can be congenital or acquired and can remain dormant all your life.

Symptoms: the infection manifests itself with swelling or reddening of the overlying skin with pus or blood discharge, with fever and localised pain.

Diagnosis: This is done by inspecting the sacrococcygeal region and an ultrasound can be used to define the size.

Causes: the most accredited cause is the build up of hairs that can become infected and cause an abscess. Friction can contribute to their formation.

The US marines during the Vietnam War had 47,000 cases as a result of driving jeeps, hence the term jeep disease.

The condition mostly affects people with a lot of body hair who lead sedentary lives and have poor hygiene.

Treatment: in some cases local hair removal and antibiotic or anti-inflammatory treatment are the option of choice. In the case of infection, the only permanent treatment is surgery. The techniques are varied and range fromtotal excisionto reconstruction with skin flaps or the endoscopic EPSIT  technique that removes the cyst through a small incision. The important thing is that these treatments must be performed by a proctologist.

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