Anorectal Surgeries: Specialized Procedures for Anal and Rectal Conditions

WHAT ARE ANORECTAL DISORDERS?

The anus is a complex structure comprised of glands, muscle rings in the anal canal, and an involuntary anal sphincter. Working in harmony, these components control bowel movements. Anorectal disorders encompass various conditions affecting these crucial areas.

Anorectal disorders constitute a range of ailments, such as tears in the anus and rectum, anal fissures, fistulas, hemorrhoids, and even cancer. While most conditions are benign, they necessitate medical attention to prevent potential complications. Unfortunately, individuals often refrain from seeking medical help for anorectal issues, leading to the possible worsening of these conditions.

Identifying anorectal disorders can be crucial. Symptoms often manifest as:

• Pain
• Itching
• Anal bleeding
• Swelling
• Incontinence
• Burning sensation
• Presence of blood in the stool

Early detection and proper management are pivotal in addressing anorectal disorders effectively, ensuring timely treatment and relief from discomfort.

TYPES OF ANORECTAL CONDITIONS

At Proliance Surgeons Surgical Specialists of Edmonds, we’ve successfully treated numerous patients dealing with a spectrum of anorectal disorders. Our approach prioritizes understanding your specific concerns, ensuring a comfortable and personalized visit. Common anorectal conditions include:

• Anal Fissure: Often arising from constipation or straining during bowel movements, these small tears in the anal canal can also result from chronic diarrhea. Symptoms include severe sharp pain during bowel movements and bright red blood.

• Anal Fistula and Abscess: An abscess, an infected tissue pocket around the anus, can lead to a fistula—an abnormal connection between the anal canal and the skin. Symptoms encompass pain, fever, redness, and bloody discharge or stool, often necessitating surgical intervention.

• Pilonidal Disease: Occurs when broken hair penetrates small breaks in the skin, leading to inflammation and infection. Symptoms involve pain, redness, drainage, or abscesses in the anal area.

• Hemorrhoids: These are blood vessels in the anal lining that, when inflamed, cause noticeable discomfort, such as bleeding, itching, and pain during bowel movements.

Recognizing the specific nature of each anorectal condition is vital in providing tailored treatment approaches for our patients.

DIAGNOSING ANORECTAL CONDITIONS

Medical professionals utilize various tools to accurately diagnose anorectal conditions, ensuring a precise understanding of the patient’s health concerns:

• Biopsy: This involves the extraction of a small tissue sample for examination, commonly employed to assess polyps and tumors, determining their nature, whether benign or cancerous.

• Anoscopy: A diagnostic technique employing a small, tube-like instrument equipped with a light inserted into the anus. This allows visualization of the final few inches of the rectum and anal canal.

• Colonoscopy: This procedure involves examining the entire large intestine under moderate sedation. It requires thorough bowel preparation and aids in detecting rectal and colon cancers or abnormalities.

• Flexible sigmoidoscopy: Similar to a colonoscopy but focusing solely on the rectum and sigmoid colon rather than the entire large intestine leading to the rectum.

• Ultrasound or MRI: Non-invasive imaging tests revealing the structure and functionality of the anal canal, sphincter muscles, and rectum.

By employing these diagnostic tools, healthcare professionals can accurately assess anorectal conditions, facilitating appropriate treatment measures tailored to each patient’s needs.

UNDERSTANDING ANORECTAL SURGERIES

Anorectal surgeries are specialized surgical procedures aimed at repairing or reconstructing the anus. Situated at the terminal end of the large intestine, the anus spans approximately 3-4 centimeters. Encircling it are circular muscles called sphincters, crucial for expelling waste from the body.

These surgical interventions focus on rectifying issues within and around the anus. Some conditions may be congenital, while others result from injury or disease.

At our facility, expert surgeons conduct anorectal surgeries, ensuring precise explanations, specialized care, and tailored surgical procedures to address diverse anorectal conditions effectively.

TYPES OF ANORECTAL SURGERIES

Anal Fistula Surgery

For smaller fistulas, outpatient procedures suffice. Larger fistulas necessitate advanced techniques such as:

• Fistulotomy: Removal of the entire fistula and surrounding tissue.
• Seton Drain: A surgical thread looped through the fistula for drainage or to block the tract, aiding the healing of the surrounding tissue.
• Endorectal Advancement Flap: This procedure is done by excising infected tissue at the inside opening and closing it with healthy rectal tissue while it drains through the outside opening.
• LIFT or Ligation of Intersphincteric Fistula Tract: It is the closure of the fistula between sphincter muscles (commonly by stitches) before the surgeon removes the fistula tract or infected tissue inside.
• Hemorrhoidectomy

Severe cases of hemorrhoids may require surgical removal of the hemorrhoid and surrounding tissues, while nonsurgical procedures suffice for milder cases.

Colorectal Conditions

The Colorectal Area

The colon and rectum are both part of the large intestine, and each serve specific functions in the digestive process. The colon absorbs water from digested food so it can be used throughout the body, and it processes the food to expel waste. The rectum is the final part of the large intestine and temporarily stores the waste before being emptied through the anal canal, or anus.

Together, the colon and rectum make up the large intestine and conditions that affect this area can be referred to as colorectal or intestinal disorders. Many of these conditions are quite common, such as chronic constipation, and are easily treatable. Other ailments that fall under colorectal disorders can be life-threatening, such as colon or anal cancer.

Colorectal Diagnostics

To diagnose or discover colorectal disorders, doctors have a variety of techniques and tests at their discretion:

• Anal manometry: used to evaluate how well the muscles in the anus and rectum are working. The test is to diagnose fecal incontinence and chronic constipation.
• Capsule endoscopy: using a tiny camera placed inside a pill-size capsule and swallowed, it will take pictures of the gastrointestinal tract and transmitted to a device worn around the waist.
• Colonoscopy: using a camera attached to a thin and flexible tube (colonoscope), the tool is inserted into the anus so the doctor can see inside the colon and rectum to detect any abnormalities.
• Endoscopic ultrasound: a procedure that combines an endoscopy with an ultrasound to capture high quality images of the digestive tract. This is primarily used to diagnose colon cancer.
• Sigmoidoscopy or flexible sigmoidoscopy: a diagnostic procedure that is similar to a colonoscopy. Using a colonoscope with a camera attached at the end, the doctor looks at the last portion of the colon that is closest to the rectum to check for any abnormalities.

Colorectal Diseases and Conditions

There is a wide range of conditions and diseases that affect the colon and rectum, two of the most common diseases are:

Rectal/colon cancer

While both of these cancers can be referred to as colorectal cancer, the difference between the two is where they begin. Rectal cancer begins in the rectum and colon cancer starts in the colon. The majority of this type of cancer develops from a precancerous polyp, which arise from cellular mutations and begin to spread.

Diverticulitis

Pockets or small pouches, called diverticula, which develop in the sigmoid (lower) colon. While most people don’t notice this development, some may experience problems relating to it, such as lower gastrointestinal bleeding, inflammation, and infection of the diverticula. The infection is specifically diverticulitis.

Other colorectal disorders include:

• Anal Abscess/Fistula
• Crohn’s Disease
• Anal Fissure
• Hemorrhoids
• Ostomy
• Pilonidal Disease
• Ulcerative Colitis

What is the Foregut?

The foregut or upper gastrointestinal tract (GI tract) is an area of the body that includes the stomach, esophagus, and upper small intestines.

Foregut disorders and diseases often require a multidisciplinary approach due to their many components, which is especially true for diagnoses. While the GI tract includes many other sections of the body, the foregut is strictly the upper gastrointestinal tract; this means diseases and conditions that affect lower parts, such as the colon, are excluded from diseases and conditions of the foregut.

Conditions of the Foregut

There are several conditions and diseases that affect various parts of the upper GI tract, including:

• GERD (heartburn): a chronic condition where stomach acid or bile flows back through the esophagus and irritates the lining, causing discomfort and a burning sensation. Most adult experience heartburn casually, but when it is persistent or recurrent, it can indicate GERD ( Gastroesophageal Reflux Disease). This can be treated with medication, lifestyle changes, or surgery.
• Hiatal Hernia: A type of hernia where the stomach is forced up through the diaphragm and has been known to cause GERD. The stomach will bulge through the large muscles separating your abdomen and chest, the diaphragm, and is treated with surgery.
• Gastric cancer (stomach): cancer of the stomach lining that causes symptoms of indigestion, stomach pain, nausea, unintentional weight loss, and black stools. The treatments include chemotherapy, radiotherapy, and surgery.
• Peptic Ulcer disease: a sore on the lining of the stomach, esophagus, or small intestine. There are two sub-types of ulcers within the Peptic ulcer category: gastric (inside of the stomach_ and duodenal (on the inside of the upper part of your small intestine). Symptoms include burning stomach pain, intolerance to fatty foods, heartburn, and nausea. Treatment includes medication and surgery if a serious complication has arisen from the ulcer.

What is Laparoscopic Surgery?

Laparoscopic surgery is a minimally invasive surgical technique used in the abdominal and pelvic areas with a laparoscope. The laparoscope is a thin, telescopic rod with a camera at the end which allows surgeons to see inside the body without making a larger incision. The incisions made for laparoscopic surgeries are 2-4 small incisions of half an inch or less instead of the 6-12 inch incisions made in other types of abdominal surgery.

There are numerous advantages to having laparoscopic surgery instead of other techniques used, such as:

• Less pain medication used
• Less wound pain during recovery
• Less trauma to the abdominal wall
• Reduced risk of hemorrhage
• Smaller scars
• Shorter hospital stays
• Faster recovery time
• Reduced risk of infection in the wound

Laparoscopic Surgical Procedure

Laparoscopic surgery can be used for a range of conditions, which means the exact nature of the procedure can vary. At its core, the following is how a laparoscopic surgery would proceed.

1. Preparation

Laparoscopic surgeries are performed while the patient is under general anesthesia, this means the patient would need to avoid eating and drinking for eight hours prior to the procedure being done. Due to the anesthesia, you’ll need someone to drive you home following the surgery.

In some cases, the surgical team may want testing done prior to the operation, such as blood tests and imaging of the surgical site. If that is required and after it has been performed, you’ll be moved into the operating room and anesthesia will be administered.

2. The Surgery

Beginning with a small incision near the belly button or pelvic bone, the first is to pump carbon dioxide into the abdominal or pelvic cavities. The surgeon will then insert the first trocar and place the gas tube within it to inflate the abdominal or pelvic cavity to help separate the abdominal wall from your organs and make it easier to see on the monitor.

After inflating, the surgeon removes the gas tube and places the laparoscope through the trocar to have real-time video images of the surgical site. The images will help the surgeons place and use the other surgical instruments. Depending on the reason for the operation, the surgeon may make one or more keyhole incisions and place trocars in them as well as laparoscopic surgery requires instruments that are designed to fit through the trocars.

Once the operation is completed, the surgeon will let the gas exit the body before closing the incisions.

3. Recovery

Once your incisions are closed, you’ll be moved to a postoperative recovery room where you’ll be monitored until you wake up. It is common to feel some pain from the residual carbon dioxide and it’s usually in the shoulder area, but the pain subsides in a day or two following the operation.

After waking, the healthcare team will give instructions on home care and wound care.

What are Skin and Soft Tissue Diseases?

The skin is the largest organ in the body and protects us from the elements and microbes that attempt to invade our bodies. There are three layers to the skin: the epidermis, dermis, and subcutaneous fat, each having a variety of medical conditions that can arise.

Most skin disorders do not require a surgeon to treat, but sometimes skin conditions do require surgery.

The common skin ailments we see are skin cancers including melanoma, basal cell carcinoma and squamous cell carcinoma. Most of the benign processes needing surgery are related to various infections including sebaceous cysts, abscesses and hidradenitis.

The soft tissues generally refer to the subcutaneous (below the skin) fat and the muscles. Again there are many benign processes that cause a mass or swelling in the body. The vast majority of these are benign fatty tumors called lipomas, but various types of cancer can arise in the soft tissues.

Conditions Treated

Common types of skin and soft tissue surgery include:

• Drainage of abscesses
• Biopsy or removal of skin lesions
• Removal of lumps, such as cysts or lipomas

While many people go to a dermatologist for skin-related issues, a general surgeon would perform most skin and soft tissue surgeries. If the procedure is more complex, such as a flap or reconstruction, you may need a plastic surgeon.

Proliance Surgical Specialists of Edmonds treats the following:

• Lipomas: a fatty tumor located just below the skin and is usually harmless, and slow-growing
• Sebaceous cysts: a typically harmless and slow-growing bump under the skin. Sometimes referred to as epidermal inclusion cysts. Often removed to prevent infection or abscess
• Skin Cancer: such as melanoma, basal cell carcinoma, and squamous cell carcinoma.

What to Expect from Skin and Soft Tissue Surgery

The majority of skin and soft tissue surgeries are done in the office under local anesthetic. The remainder are done as outpatient surgery at our surgery center. Your health history, preferences, and the specific skin and soft tissue disease will largely determine what is safest.

Skin and soft tissue surgery is aimed at removing the problem permanently. Sometimes this is an urgent or emergent situation such as with an abscess. Most of the time these surgeries are completely elective, which means we have planned the surgery and scheduled it out from the initial visit. Elective doesn’t mean cosmetic so most of these procedures are covered by insurance. However, some skin and soft tissue surgeries can be cosmetic, such as removing scar tissue or a lump for no medical reason.

For recovery, most patients can return to work the same day or the next day. If you have surgery at the surgery center and require anesthesia you will need a driver on the day of surgery but should return to normal activity the next day. For most surgical wounds absorbable sutures will be used. You will be asked to keep the wounds dry for 48 hours and not immerse in water for 2 weeks. You can shower after 48 hours but no baths, hot tubs, or swimming for 2 weeks. There will typically be no activity restrictions but ask your surgeon if there are any restrictions.