Proctologic surgery

Conditions treated by proctologic surgery

• Internal and external hemorrhoids: When symptoms such as bleeding, prolapse, or pain are unresponsive to medical treatments.
• Chronic anal fissures: Not resolved by topical or medicinal treatments.
• Anal fistulas: Abnormal connections between the anus and skin requiring targeted management.
• Anorectal abscesses: Infections that require surgical drainage.
• Rectal prolapse: Descent of the rectum, often associated with incontinence.
• Anal condylomas and lesions: Of infectious or oncological origin.
• Anorectal tumors: Requiring surgical resection.

Main surgical techniques

Below is an overview of commonly used techniques depending on the condition:

1. For hemorrhoids

• Traditional Hemorrhoidectomy (Milligan-Morgan or Ferguson technique): Surgical removal of hemorrhoidal tissue. Recommended for Grade IV hemorrhoids or severe cases.
• Stapled Hemorrhoidopexy (Longo technique): Reduces prolapse and repositions internal hemorrhoids. Less painful, with a shorter recovery time.
• Radiofrequency Treatment (Rafaelo technique): A minimally invasive method using radiofrequency waves to shrink hemorrhoids.
• Rubber Band Ligation (Banding): A non-surgical technique suitable for Grade I to III internal hemorrhoids.

2. For anal fissures

• Lateral Internal Sphincterotomy: Partial cutting of the internal sphincter muscle to reduce pressure and promote healing.
• Botulinum Toxin Injections: Temporarily relax the sphincter muscles; effective in certain chronic cases.

3. For anal fistulas

• Seton Placement: A thread is placed to allow drainage and gradual healing of the fistula.
• Fistulotomy: The fistula is surgically opened to heal from the inside out.
• Laser Technology (FiLaC): Fistula closure using a laser beam; minimally invasive technique.

4. For rectal prolapse

• Laparoscopic or Robotic Rectopexy: The rectum is fixed to the pelvic wall to restore anatomical positioning.
• Delorme Technique: Resection of prolapsed mucosa, suitable for milder cases.

5. For anorectal abscesses

• Surgical Drainage: A straightforward procedure to drain pus and prevent further complications.

General surgical indications

Proctologic surgery is indicated when:

• Medical treatments (creams, suppositories, laxatives) have failed.
• Symptoms significantly impair quality of life (pain, bleeding, incontinence).
• Complications arise (thrombosis, infections, severe prolapse).
• A malignant or precancerous condition is diagnosed.

Conclusion

Proctologic surgery offers a wide range of techniques tailored to each condition. A personalized evaluation is essential to determine the most appropriate approach, taking into account patient preferences and technological advancements.