Indications for anal surgery

Fissures :

Fissurectomy + leiomyotomy or section of the internal sphincter with mucosal anoplasty.

 

Haemorrhoids :

Individual group haemorrhoidectomy by the modified St Mark's Hospital technique.

 

Anal abscess :

Incision and wide exposure of the anal communication.

 

Fistulae :

Often after drainage for a few weeks block excision of one or several fistulous tracts, excluding, when appropriate, part of the deep transphincteric tract, which is eliminated by elastic traction after the patient leaves hospital.

 

Note : All specimens removed at operation must be examined histologically.

 

 

Note :

No surgery is really minor. Anal surgery requires competence and rigour, as much if not more than any other type of surgery.

 

A poorly performed operation may lead to recurrence, discomfort and sometimes to lifelong disability.

Thus, the referring physician and the surgeon bear a great responsability : if the surgeon does not feel competent to deal with the whole problem he should pass the patient on.

He will gain the gratitude of all concerned.

 

 

GENERAL CONCLUSION

 

Proctology has long been neglected, poorly understood ans ignored, partly because it deals with an embarrassing part of the body, one about which both doctor and patient fond it difficult to talk.

Moreover, anal surgery had a very bad name because it was performed in poor conditions, at the end of a list of operations, and the postoperative course was very painful.

This image has been destroyed.

Important advances have occurred in the last few years and the general practitioner is aware of them.

His role is of cardinal importance, both physically and psychologically, since, if he is willing and knowledgeable, he can not only relieve his patient's symptoms but also reassure him to the point where he can face investigations ans complicated treatment with confidence and calm.

 

In anal surgery performed with patience and rigour, with the postoperative course under the direct supervision of the surgeon himself, the results are on the whole excellent, the postoperative course realtively free from painand recurrences almost non-existent.