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Your Anal Problems

Common Symptoms of Anal Fistula

• Persistent discharge of pus through an external opening in perianal skin.
• Pain and swelling
• Fever

Pelvinic's Approach Towards Problem

The biggest challenge in treating fistula is to prevent recurrence. World over the recurrence rate of fistula is 5 to 7 %. According to Dr Sandip Banerjee, a leading Coloproctologist , a successful fistula surgery requires proper diagnosis, a good MRI done and well reported, the surgeons expertise and the method of surgery. Dr Sandip Banerjee does LASER FILIAC, LIFT, Fistulotomy for fistula. Choice of surgery depends upon the type of surgery. In almost all cases Dr Banerjee does in single settings and the success rate with him is more than 90%

Laser treatment for Anal Fistula/ Bhagander

Dr SANDIP BANERJEE has achieved expertise in treating complicated fistula in single setting by LASER FILIAC surgery. Dr Banerjee deliver LASER energy via special fibers into the fistula tract after proper defining it. LASER is supposed to close and obliterate any abnormal paths in a fistula and also causes destruction of inner lining cells of fistula tract thereby simultaneous obliteration of remaining fistula tract. The tract destruction occurs in a very controlled way and the fistula tract collapses to a very high degree. Compared to conventional surgery LASER energy is better controlled, achieves best results with no cutting or charring of the tract all in few minutes. Can be done in clinic settings.

Common Symptoms of Fissure in Ano

• A visible tear in the skin around the anus
• Sharp pain in the anal area during bowel movements
• Streaks of blood on stools
• Burning or itching in the anal area

Pelvinic's Approach Towards Problem

The goal of treatment for anal fissures is to break the cycle of spasm of the anal sphincter and its repeated tearing of the anoderm. Majority of patients (70%) respond to medical management by Dr Banerjee. Remaining cases of chronic fissure requires a day care procedure called Internal Sphinterectomy/ fissurectomy.

Laser treatment for Fissure in Ano

The conventional method of Internal sphincterotomy is now mostly replaced by LASER procedure and according to Dr Sandip Banerjee, more and more patients with Fissure are bow opting for Laser treatment. Laser treatment is the most modern procedure in Fissure and it causes vaporization of of pathological tissue of Fissure without giving additional cut. Very less operating time and is a day care procedure with early resuming to job.

Common Symptoms of Pilonidal Sinus

• Persistence on and off serous or purulent discharge from a very small opening.
• Pain, itching and redness in affected area.
• Fever during abscess formation

Pelvinic's Approach Towards Problem

Pilonidal sinus needs proper excision. Earlier surgeon use to excise it wholly leading to large defect which resulted in pain and daily dressings. Dr Sandip Banerjee practises a noval method of wide excision with local flap cover which he called as Rotational flap which removes the chances of recurrence as well as open defect. Success rate is 100%.

Laser treatment for Pilonidal Sinus

As compared to conventional surgery, LASER treats Pilonidal sinus in the depth. It is literary a non invasive , totally painless and has great power of healing. LASER removes infected structures and sinuses from the tissue and it takes very much less time in surgery. LASER energy causes minimal or no collateral tissue damage and hence post operative recovery is excellent with no risk of recurrence. Similarly Dr Sandip Banerjee s special flap surgery after total removal of sinus is also very effective and eliminates postoperative pain and long dressings. Dr Sandip has 100 % Result of complete Pilonidal sinus treatment with both LASER and flap surgery with almost zero recurrence

Common Symptoms of Anal abscess

• Pain, which is usually constant, throbbingand worse when sitting down
• Skin irritation around the anus
• Swelling, redness, and tenderness
• Discharge of pus

Pelvinic's Approach Towards Problem

Surgical incision and drainage is the most common treatment for all types of anal abscesses and is usually successful. According to Dr Sandip, anal abscess should always be drained by Coloproctologist. About 50% of patients with an anal abscess will develop a complication called a fistula.

Common Symptoms of Obstructive Defecation Syndrome

• Feeling more stool remains in your rectum after attempting to pass stool
• Passage of hard stools
• Excessive or prolonged straining while passing stool
• Routine use of laxatives or enemas
• Pain in pelvic area

Pelvinic's Approach Towards Problem

The main concern in ODS cases is how to diagnose the main problem. Other than listening patiently to entire patients’ history, Dr Banerjee recommends additional tests to aid in diagnosis Colonoscopy/ MRI defecography to view the entire colon and look for abnormalities. Some cases even do require Electromyography (EMG) to test for weakness in the pelvic floor muscles and the muscles surrounding the anus. As far as treatment is concern, it’s all depending on the underlying cause of your obstructive defecation.

Treatment may include:

• Medications to alleviate constipation
• Biofeedback to help you regain control of your muscles
• Surgery to repair or correct anatomical deformities (STARR). This surgery uses 2 staplers which are little

different from those staplers used for piles surgery. STARR surgery if done in an ideal patient bears fruitful results. Hence don’t ignore your chronic constipation and related problems.

Laser treatment for Obstructive Defecation Syndrome

The conventional method of Internal sphincterotomy is now mostly replaced by LASER procedure and according to Dr Sandip Banerjee, more and more patients with Fissure are bow opting for Laser treatment. Laser treatment is the most modern procedure in Fissure and it causes vaporization of of pathological tissue of Fissure without giving additional cut. Very less operating time and is a day care procedure with early resuming to job.

Common Symptoms of Rectal Polyp

• Blood in the stool or rectal bleeding
• Pain, diarrhea, or constipation that lasts longer than one week
• Nausea or vomiting if you have a large polyp

Pelvinic's Approach Towards Problem

Rectal polyp needs diagnosis, and it is better if they are dealt by Coloproctologist. At Pelvinic patients with rectal polyp are first seen and diagnosed through proctoscopic examination and Dr Banerjee uses Radiofrequency ablative technique. A longer length electrode is passed and encircling coagulation field is made till the mass is separated. This process ensures very negligible bleeding and the patient can resume work the next day. Excised polyp is sent for histopathological examination.

WHAT ARE THE SYMPTOMS of Gall stone disease?

Patients with Gall stones has a non functioning gall bladder and once stone is formed inside patient started getting mild to moderate digestive problems like bloating, feeling of right sided upper abdominal discomfort, sense of indigestion or heaviness after meals or even gastritis. Small stones has the potential to slip from gall bladderneck and can get trapped inside lower end of wide bile duct called as Common bile duct. Small stones trapped there can give rise to increasing Jaundice with sudden pain and fever and resulting in surgical emergency. It can also give rise to a more morbid condition called as Acute pancreatitis. Both of the above problem demands urgent hospital admission and immediate endoscopic intervention followed by surgery.

Large stone can get blocked inside gall bladder and can give rise to episodes of repeated infection and swelling resulting in recurrent right upper abdominal severe to moderate pain. Pain can radiate to right upper back bone and can be associated with fever in case of infection.

WHAT SHOULD ONE DO IN CASE OF CONFIRMED GALL STONE DISEASE

Above said symptoms may lead your doctor to ask you to undergo an Ultrasound of abdomen in fasting stomach. Once confirmed in USG findings then your surgeon will ask for the surgery. Surgery is required to remove the non functioning gall bladder before it causes any complications

WHAT CAN HAPPEN IN CASE ONE DON'T GO FOR SURGERY

Many patients with Gall bladder stone can remain asymptomatic for many years. However the proven problems which can occur in neglecting surgery is Continuation of above said problems

• Exaggeration of mild symptoms
• Repeated episodes of pain
• Obstructive jaundice
• Inflammation of Pancreas
• Gall bladder cancer

HOW IS THE SURGERY FOR GALL BLADDER STONE DONE?

These days gall bladder removal surgery is being done by minimal invasive surgery called as Laparoscopic cholecystectomy surgery. Laparoscopic surgery for gallbladder was first done in 1980. After that a lot of further technological advances has happened and the procedure has become very safe and can be done in half a day procedure called Day care surgery. Ideally 4 small incisions are placed over tummy ( 2 incisions of 1 cm and rest 2 of 1/2 cm). On the day of surgery patient is asked to come with overnight fasting. Anesthetist gives General anaesthesia that is complete deep sleep and the surgeon performs the surgery for approximately 30 to 60 mins. Post surgery patient is brought back to senses and kept nill per mouth for another 4 to 6 hours. Patient can be either discharged in same day or next day. Patient is allowed normal home cooked food from next day and can resume work in another 3 to 5 days

INGUINAL HERNIA

The most common type of hernia is the inguinal hernia. An inguinal hernia happens when contents of the abdomen, usually fat or part of the small intestine bulge through a weak area in the lower abdominal wall. The abdomen is the area between the chest and the hips. The area of the lower abdominal wall is also called the inguinal or groin region. Generally speaking, an inguinal hernia can be felt as a lump under the skin in the groin region.

Two types of inguinal hernias are

• Indirect inguinal hernias, which are caused by a defect in the abdominal wall that is congenital, or present at birth
• Direct inguinal hernias, which usually occur only in male adults and are caused by a weakness in the muscles of the abdominal wall that develops over time

VENTRAL HERNIA

A ventral hernia is a bulge of tissues through an opening of weakness within your abdominal wall muscles. It can occur at any location on your abdominal wall.

Many are called incisional hernias because they form at the healed site of past surgical incisions. Here abdominal wall layers have become weak or thin, allowing for abdominal cavity contents to push through.

In a strangulated ventral hernia, intestinal tissue gets tightly caught within an opening in your abdominal wall. This tissue can’t be pushed back into your abdominal cavity, and its blood flow is cut off. This type of ventral hernia is an emergency requiring surgery.

UMBILICAL HERNIA

An umbilical hernia occurs when part of the intestine protrudes through the umbilical opening in the abdominal muscles. Umbilical hernias are common and typically harmless. They are most common in infants, but they can affect adults as well.

INCISIONAL HERNIA

An incisional hernia is a type of hernia caused by an incompletely-healed surgical wound. Since median incisions in the abdomen are frequent for abdominal exploratory surgery, ventral incisional hernias are often also classified as ventral hernias due to their location.
After abdominal surgery in which an opening is made in the abdominal wall, the resulting scar creates a weak point in the muscle layer, through which body tissue can protrude.

HIATAL HERNIA

A hiatal hernia occurs when part of your stomach protrudes up through the diaphragm into your chest. The diaphragm is a sheet of muscle that helps you breathe by contracting and drawing air into the lungs. It separates the organs in your abdomen from those in your chest.

This type of hernia is most common in patients over 50 years old. If a child has the condition, it’s typically caused by a congenital (birth) defect. Hiatal hernias almost always cause Gastroesophageal Reflux (GERD), which is when the stomach contents leak backward into the oesophagus, causing a burning sensation.

What symptoms are caused by hernias?

• Failure of the abdominal wall to close properly in the womb, which is a congenital defect
• Chronic coughing
• Damage from injury or surgery
• Factors that strain your body and may cause a hernia, especially if your muscles are weak, include
• Being pregnant, this puts pressure on your abdomen
• Being constipated, this causes you to strain when having a bowel movement
• Heavy weight lifting
• Fluid in the abdomen or ascites
• Suddenly gaining weight

RISKS ARE ASSOCIATED WITH HERNIAS

The weak point of the muscle wall will not close up by itself. In fact, the hernial opening will increase in size each time the hernia recurs. If the intestine trapped in the hernia sac, the blood supply may cut off and the tissue will die. Furthermore, the contents of the herniated section of the intestine may be pre4vented from passing through (bowel obstruction).

PELVINIC S APPROACH TOWARDS YOUR HERNIA PROBLEM

At PELVINIC , treatment plan is optimised according to different types of hernia and patients. The treatment plan is discussed with individual patient and explained. Dr Sandip Banerjee, a laparoscopic hernia repair expert does a variety of hernia repair methods. Laparoscopic surgeries include TAPP, TEP for Inguinal hernia, Laparoscopic Nissens / Toupets Fundoplication for Hiatus hernia problem. For ventral/ umbilical/ incisional hernia the procedure he performs is called as laparoscopic ventral hernioplasty.

Choice of mesh is an important factor which determines the efficacy of treatment outcome and overall cost attached to the procedure. Dr Banerjee prefers to use simple polypropylene meshes for inguinal hernia and composite dual meshes for ventral hernia. At Pelvinic, proper devised surgical guidelines help our patients to have highest number of successful results in hernia care.