Perianal Surgery (Rectal and Pilonidal Sinus Surgery)
Definition and Symptoms of Pilonidal Sinus
Pilonidal sinus (derived from the Latin words' pilus ("hair") and nidus (“nest”) is a condition, which has been debated. It may be detected as one or several holes in the skin at the top of the buttocks, where they divide (the cleft). Oftentimes it is detected when infected and requires antibiotic treatment and drainage of inflammation. Once inflammation occurs, the following episodes occur easily. Surgery will be planned according to the findings.
Treatment may require sclerotherapy or surgery, where the pouch is removed. Repetition rate, postoperative comfort, and recovery may vary depending on the methods used. Please certainly discuss these conditions with your doctor. Surgical procedures performed at our hospital:
- Laser sclerotherapy
- Sinusectomy
- Pilonidal sinus excision (surgical removal) and leaving for secondary recovery
- Pilonidal sinus excision (surgical removal) and flap placement
Hemorrhoid
Swellings that are located immediately under the skin around the anus or inside the rectum are called hemorrhoids. Hemorrhoids are swollen, enlarged veins and are structurally like varicose veins. They are known as internal hemorrhoids if they develop inside the rectum and prolapse outside the anal canal and as external hemorrhoids if they develop under the skin around the anus. The reason for hemorrhoids is the increase in intraabdominal pressure for any reason. The possible reasons for this include long-term constipation, sitting a long time on the toilet, pregnancy, obesity, and a low-fiber diet.
Internal hemorrhoids are graded according to the degree of prolapse. Grade I hemorrhoids prolapse in the rectal canal and develop due to strain during defecation. Grade II internal hemorrhoids prolapse outside of the anal canal during defecation and return inside after defecation. Grade III internal hemorrhoids cannot return to their place on their own and require pushing by hand. Grade IV hemorrhoids never return inside and are permanently outside.
Treatments offered at our hospital
- Endoscopic band ligation
- Endoscopic sclerotherapy
- Laser sclerotherapy in an operation room
- Hemorrhoidectomy (surgical removal)
- Hemorrhoidectomy with a stapler (Longo procedure)
Anal fissure
An anal fissure is a linear wound (tear) on the tissue lining anus. Since there are many nerves in this place, an anal fissure may cause severe pain and tenderness. The main reason for an anal fissure is the permanent contraction of the internal (inner) rectal muscle. It is known as an acute anal fissure to the 6th-8th week after the onset of findings, and it may be mostly treated with toilet habit, stool softener, diet change, sitz bath, and medical treatment (conservative treatment).
On the other hand, a chronic anal fissure may be treated with long-term conservative treatment; however, strict compliance to treatment and patience is required. In case is conservative treatment is not beneficial; some patients may undergo a surgical procedure known as lateral internal sphincterotomy. This procedure is performed under anesthesia. The internal rectal muscle is cut and therefore, pressure is reduced, and the anal fissure heals.
Perianal abscess and fistula
Perianal abscess is the development of an inflammatory focus in soft tissues around the rectum and accumulation of pus (abscess). It is considered due to an obstruction at the outlet of crypt glands, which are located in the anal canal. The location and size of the abscess determine the seriousness of the clinical findings. The most common symptoms are usually pain, swelling, erythema (redness), and fever around the anus. It may be diagnosed with a physical examination; however, sometimes investigations such as ultrasonography or MRI may be required.
An abscess is generally treated by drainage under anesthesia. A single incision is made to the closest place to the abscess pouch, and it is drained. Then, the abscess pouch is controlled.
The perianal fistula is the path that connects the anal canal and the skin. The fistula generally develops on the background of the perianal abscess. A wound or an opening with discharge, erythema (redness), and sometimes pain or itching may be observed around the anus. If a patient presents with these complaints, (s)he may be diagnosed during the examination. However, further investigations may be required for some cases. Investigations such as superficial ultrasonography, and MRI may reveal the course and features of a fistula.
Perianal fistula is treated surgically. The main principle for surgical treatment is to preserve the anal muscles (anal sphincter). Therefore, revealing the anatomy of the fistula before surgery is essential.
In some simple cases, the fistula tract (path) may be simply opened and left for healing on its own. However, in the case of complicated fistulas, several techniques may be required:
- Laser sclerotherapy
- Seton stitch (a thick string is inserted into the fistula tract).
- In addition to the above-mentioned techniques, opening ostomy (surgery to temporarily connect the colon to the anterior abdominal wall to prevent the passage of waste through the anus).