WHAT IS PILES?

Piles (Haemorrhoids) is a bunch of broadened veins in the anus and the lower rectum. The rectum is the last range of digestive tract which continues as the anus, from where stools are excreted.

Piles (Haemorrhoids) is generally classified into two:

1.     Internal piles start in the lower rectum and don’t come out of the anal opening
2.     External piles start in the lower rectum and remain outside the anal opening

SYMPTOMS OF PILES

Enlarged Piles are associated with symptoms such as

1.     Painless bleeding while passing stools
2.     Itching
3.     Mucus discharge
4.     Burning on and around the anus
5.     Severe pain, if the complication occurs
6.     The sensation of incomplete evacuation

CAUSES

Few things that can cause piles are:

1.     Chronic constipation
2.     Obesity, pregnancy, cirrhosis of the liver
3.     Standing or sitting for long durations
4.     Consuming a low fiber diet
5.     Overconsumption of junk, spicy and fried food. i.e people who are always in hurry, mostly worry and eat spicy curry

Usual Treatment options for Piles

1.     Change of diet and lifestyle (Grade I)
2.     Lotions, medicaments, ointments (Grade I)
3.     Rubber band, sclerotherapy, infrared coagulation (Grade I +II)
4.     Laser hemorrhoidoplasty
5.     Closed surgery: stapler hemorrhoidoplasty (Grade III+IV) M.I.P.H.
6.     Open surgery: milligan-morgan, parks (Grade III+IV)

The advantage of Laser Haemorrhoidoplasty

1.     Postoperative period is least painful
2.     Day care procedure
3.     Chances of postoperative bleeding are minimal
4.     Generally, postoperative dressing is not required
5.     No rectal stenosis
6.     No incontinence
7.     Can be done in post-C.A.B.G and postpartum patients
8.     Several repetitions possible

WHAT IS ANAL FISSURE?

An anal fissure is a little tear or split in the coating of the anus. It might happen while passing hard stools.

It can bring about sharp pain and bleeding during and after defecations. It might likewise bring about tingling and blaze in the anal region. Sometimes the pain gets too serious, that patient suffers vertigo and perspiration on a passing stool. Few patients suffer discomfort while sitting. Sometimes, a pricking sensation is felt. And often patients complain of difficulty in passing stools due to narrowing of the anal canal, caused by spasm of internal sphincter.

It is normally a minor condition that persists only for a 3-4 week. Most of the time tear heal on its own. Home remedies can help ease the torment.

It may happen subsequently after delivery or any major surgery. This occurs in an individual of any age, yet it’s regularly found in new-born children and youthful kids.

SYMPTOMS OF AN ANAL FISSURE

It may bring about at least one of the accompanying indications:

• a noticeable tear in the skin around the rear-end
• a skin tag, or a little chunk of skin, by the tear
• sharp torment in the anal range amid solid discharges
• streaks of blood on stools or on tissue paper subsequent to wiping
• burning or tingling in the butt-centric range

CAUSES OF ANAL FISSURE

Anal fissure regularly happens while passing hard stools. Chronic constipation or frequent diarrhea can cause a tear in the skin around the anus. Other basic causes include:

• straining amid labor
• decreased bloodstream to the anorectal range
• the overly tight or spastic butt-centric sphincter muscle

In uncommon cases, a butt-centric gap may create due to:

• anal tumor
• HIV
• tuberculosis
• herpes

TREATMENTS

• Sitz bath
• Local application of ointment.
• Laxatives (like isabgol, liquid paraffin)
• Tablet
• Surgery ( closed lateral sphincterotomy or laser sphincterotomy)

ADVANTAGES OF LASER SPHINCTEROTOMY

• Persistent fissures may require a lateral internal anal sphincterotomy.
• It is a highly effective treatment for a fissure.
• Recurrence rates after this type of surgery are very low.
• It is a minor operation.
• Can be performed as a day case without the need to stay overnight.
• This sphincterotomy operation helps the fissure heal by decreasing pain and spasm.
• Need for postoperative dressing is less likely.
• A laser also can be done in post CABG (Cardiac), Pregnant & Lactational Patient.
• Chances of loss of stool control (Incontinence) is not there.

WHAT IS ANAL FISTULA?

An anal fistula is a little channel that is created between the lumen of the anus and the skin close to the perianal area.

At times, It causes tireless seepage. In different cases, where the outside of the channel opening shuts, the outcome might be intermittent anal abscesses. The main cure for an anal fistula is surgery.

SYMPTOMS OF ANAL FISTULA

Conceivable indications include:

• Discharge of pus or blood on and off from the fistula opening.
• Pain which is generally consistent, throbbing and more terrible when taking a seat
• Skin excoriation and itching around the anus.
• Constipation or torment related with bowel moments
• Fever in acute cases

CAUSES OF ANAL FISTULA

The most widely recognized reason for fistula is an anal abscess, in spite of the fact that there are a few other conceivable reasons for the condition. Most anal fistulas shape in the back midline.

At the point when fistulas are found in different areas, they are regularly connected with optional conditions. These include:

• intestinal provocative illness
• sexually transmitted diseases
• injury
• tumors including leukemia
• tuberculosis
• anorectal growth
• HIV

TREATMENTS

• Open fistulectomy
• Seton tie (ligation of fistulous tract by non-absorbable thread), like keshar sutra in ayurveda,
• New innovation: laser treatment.

Comparison between Open & Laser Surgery

Open Fistula Surgery

Laser fistula surgery

ADVANTAGES OF LASER

• Excellent Healing rates.
• The postoperative dressing is required for a very short duration.
• Post-operative bleeding less likely.
• Fewer complications have been observed.
• The laser also can be done in post CABG (Cardiac), Pregnant & Lactational Patient.
• Chances of loss of stool control (Incontinence) is not there, as no sphincter damage.
• Recurrence of Fistula is uncommon after Laser treatment. 

Pilonidal Sinus

1. Laser treatment is the best treatment for pilonidal sinus.
2. There is negligible pain and faster recovery with no stitches.
3. No open wound remains after operating with <1mm laser fiber hence the need for long term post-op dressing is less likely.
4. Patient can be discharged within 6 – 8 hours of surgery.
5. Recurrence of Pilonidal sinus is less likely after the procedure.

WHY LASER FOR PILES, FISTULA, FISSURE, PILONIDAL SINUS?

1. Long term post-op dressing is not required.
2. Complaint of post-op pain is very low.
3. Good post-op results.
4. Superior operator control for Fistula.
5. Can be done in Local Anaesthesia.
6. It is a day care procedure with minimum post-op discomfort.
7. There are very few chances of bleeding as there is very less tissue damage.
8. Patient recovers very quickly.
9. Patient satisfaction is very high.
10. There is no loss of control over stool, i.e. no incontinence.

Rectal Prolapse is an illness in which Rectum turns out during defecation partially or totally, now and then it goes automatically or in some cases understanding needs to do it physically. This can happen for guys, females, and kids. While this might be excruciating, it can likewise be reasonably mortifying and frequently has an earth-shattering negative effect on patients’ personal satisfaction.

TYPES OF RECTUM PROLAPSE

Full-thickness rectal prolapse is when some portion of the mass of your rectum comes out via your rear-end. This is the most well-known sort of rectal prolapse.
Mucosal prolapse is when just the covering (mucosa) of your rectum juts out by means of your anus.
Internal rectal prolapse is the point at which your rectum twists in on itself yet doesn’t push out through your rear-end. This is additionally perceived as an interior intussusception.

SYMPTOMS OF RECTAL PROLAPSE

On the off chance that you have a prolapsed rectum, you are probably going to watch a bulge or swelling leaving you are rear-ended. At first, you may just watch this when you have defecation. Notwithstanding, if your prolapse deteriorates, this may likewise happen when you cough, sneeze or stand up. You may likewise:

• Find it dangerous to control your defecations
• See some brilliant red blood leaving your rectum
• Have some uneasiness
• Develop an ulcer on the segment of your rectum that projects out

CAUSES OF RECTUM PROLAPSE

• Excessive straining
• Chronic Constipation
• Chronic Diarrhoea
• Weakness of Rectum Supporting Muscles & Ligaments
• Some other unknown causative factors

We are Providing Stapled Transanal Resection of the Rectum STARR Surgery (For Chronic Constipation ) O.D.S.

• STARR Surgery is a surgical system that is performed through the anus, requires no outside entry points, and leaves no obvious scars.
• When a patient has symptoms of chronic constipation, they may be suffering from Obstructed Defection syndrome or ODS.
• ODS is associated with deformities in the rectum, such as the formation of rectocele (prolapse of the wall between the rectum and the vagina) or telescoping of the intestinal Wall.
• These abnormalities can cause bowel movements to become difficult, and often leave the patient with a feeling of incomplete evacuation.
• The Stapled Transanal Rectal Resection or “STARR” procedure is a new surgical procedure to help relieve these symptoms.
• The STARR Procedure removes excess tissue in the rectum, reducing the deformities that contribute to ODS.
• After the STARR Surgery, the rectum is free from obstruction, allowing for a normal bowel movement.

INDICATION OF SURGERY

•  When O.D.S. Longo’s Score is > 7
• Fecal incontinence, repeated straining
• digitation in rectum, perineum or vagina
• to aid defecation
• External Prolapse
• Enema Dependancy
• Excessive time spent in the toilet
• Sense of incomplete or unsuccessful defecation

WHAT IS PERIANAL ABSCESS?

Perianal Abscess is an agonizing condition in which a collection of pus develops near the rear-end. Most perianal abscesses are the consequence of disease from little anal glands.

The most well-known sort of abscess is a perianal abscess. This frequently shows up as a difficult bubble-like swelling close to the rear-end. It might be red in shading and warm to the touch. Perianal abscesses situated in ischiorectal fossa are less normal and might be less obvious.

Surgical cut and seepage is the most widely recognized treatment for a wide range of perianal abscesses and is normally effective.

SYMPTOMS OF PERIANAL ABSCESS

Shallow anal abscesses are regularly connected with:

• Pain, which is normally consistent, throbbing, and more terrible when taking a seat
• Skin bothering around the anus, including swelling, redness, and delicacy
• Discharge of pus
• Constipation or pain related to solid discharges

More profound Perianal abscesses may likewise be related with:

• Fever
• Chills
• Malaise

CAUSES OF PERIANAL ABSCESS

An anal abscess ulcer can have a wide range of causes. These include:

• Infection of an anal fissure. An anal fissure is a little shallow tear in the skin of the anal canal.
• Sexually transmitted contamination.
• Blocked anal glands.

WHAT IS PROCTOCOLECTOMY?

In proctocolectomy, the large intestine and rectum are Removed, leaving the lower end of the small intestine(the ileum). The specialist sews the anus closed and makes a little opening called a stoma in the skin of the lower guts. The surgical methodology to make the stoma (or whatever another manufactured opening) is called an ostomy.

The ileum is associated with the stoma, making an opening to the outside of the body. The surgery that makes the opening of the digestive system is called an ileostomy.

Stool empties into a little plastic pocket called an ostomy bag that is connected to the skin around the stoma.

This methodology may likewise be required to treat certain birth abandons or to wipe out specific type of colon or rectal growth. Specialists may likewise play out this surgery on a emergency basis if the colon or rectum injured beyond repair.

Add up to proctocolectomy with ileostomy surgery is done when other therapeutic treatment does not help issues with your digestive organ.

THIS SURGERY MAY ALSO BE DONE IF YOU HAVE:

• Colon or rectum cancer
• Familial polyposis
• Bleeding in your intestine
• Birth defects that have damaged your intestines
• Intestinal damage from an accident or injury

What is a hernia?

Dr. Md. Ahsan Habib do laparoscopic hernia surgery. Hernia occurs when an inner part of the body, such as an organ or any fatty tissue, pushes or spills through a weak spot in the muscle or tissue wall around it. There are many different types of hernias.

An inguinal hernia (inner groin):

This is the most common type of a hernia, especially in men, and occurs when the intestines push through a weak spot or tear in the lower abdominal wall, often in the inguinal canal. This type of hernia is associated with aging and happens when the abdomen is stressed repeatedly. In men, the sperm cord passes from the abdomen to the scrotum in the inguinal canal area. This cord sustains the testes. The inguinal canal contains a ligament in women that keep the uterus in place.

An incision hernia (from an incision):

Some people who have had abdominal surgery may have this condition. The intestines can push through the scar of the incision or the surrounding fabric.

A femoral hernia (outer groin), umbilical hernia (belly button):

This condition is more prevalent in women than in men. It happens when your fatty tissue or part of your intestine spills into your groin at the top of your inner thigh. Like an inguinal hernia, this type of hernia occurs due to repeated stress on the abdomen.

An umbilical hernia:

• This type of hernia occurs when the fatty tissue or part of the intestine pokes through the abdomen near the button of the belly.
• This condition may occur in infants if the opening in the abdomen through which the umbilical cord passes is not properly sealed after birth.
• This condition affects adults if the abdomen is repeatedly strained. Some other less common hernia types include epigastria hernias, spieling hernias, and diaphragmatic hernias, muscle hernias

How does hernia occur?

Hernias are usually caused by a combination of muscle weakness or connective tissue, caused by a disturbance or disruption in the natural tissue breakdown and repair cycle of the body. Increased pressure or stress in the weak tissue or muscles.

What is the treatment of a hernia?

Surgery is the only hernia treatment. However, surgery can be riskier for patients with serious medical problems.

With surgery, the weakened abdominal wall tissue can be secured and holes also closed.