SURGERY FOR BENIGN DISORDERS OF THE ANUS AND RECTUM

Summary

As a general surgeon, Dr Kavin has extensive experience in the surgical treatment of benign (non-cancerous) conditions occurring in the anus and rectum, including haemorrhoids, anal fistulas and anal fissures.

  • Haemorrhoids or piles are swollen veins located in the lower part of the rectum or anus. Piles can be internal or external. They can be caused by straining, pregnancy, or prolonged sitting, causing symptoms such as bleeding from the rectum, anal pain or itching. When piles become, problematic surgery may be needed to remove them.
  • Anal fistulas occur when an anal gland becomes clogged and forms an abscess. When an anal abscess that has been drained does not heal completely, a small tunnel may form connecting the abscess to an opening on the skin around the anus. Anal fistula causes symptoms of swelling, pain and bleeding near the anus. Surgery is then needed to clean out the track before closing it.
  • An anal fissure is a tiny tear or split in the thin lining of the anus. Anal fissures cause pain and bleeding during bowel movements and often aren’t able to heal before they re-tear. While many anal fissures can be treated without surgery, surgery may be needed to relax the muscles in the anus so that the fissure can heal properly.

If surgery becomes necessary for these conditions, Dr Kavin has the expertise to perform minimally invasive laparoscopic surgery and preserve the functioning of the sphincter muscles.

Reasons for surgery

  • Treatment of haemorrhoids
  • Treatment of anal fissures
  • Treatment of anal fistulas
  • Repair surgery for rectal prolapse

Types

1Surgery for haemorrhoids
Types:
  • Haemorrhoidectomy
  • Under general anaesthesia, Dr Kavin will gently open the anus to remove the haemorrhoid using surgical scissors or a laser. The wounds may then be sealed or left open to heal depending on their location.
  • Hemorrhoidopexy
  • Under general anaesthesia, surgical staples are used to treat a prolapsed haemorrhoid. First, the blood supply to the haemorrhoid is tied off and then stapled back into place within the rectum with surgical staples.
  • "Painless" haemorrhoidectomy (Total Haemhorroidal Dearterialzation)
A ‘painless’ Total Haemhorroidal Dearterialzation is done without the need for cutting out any tissue or making incisions. During the THD procedure, under general anaesthetic, the blood-supplying arteries of the haemorrhoid are precisely located with a specially designed proctoscope with a doppler ultrasound probe attached. Once the artery is located, your surgeon uses an absorbable suture to ligate gently or "tie-off" the blood flow to the haemorrhoid, making this technique extremely gentle and safe. As the procedure is carried out in the area above the dentate line (an area without sensory nerves), you won't feel any stitches during or after the procedure. The lack of blood flow then causes the haemorrhoid to shrink. In case of prolapsed haemorrhoidal cushions (3rd and 4th-degree haemorrhoids), a running suture with a few stitches is applied to the prolapsed piles, being careful that all stitches remain above the dentate line. The entire procedure is performed above the dentate line so that there is minimal discomfort. The procedure takes about 20 minutes and is offered as an outpatient surgery. The THD procedure differs from other surgical techniques in the following ways:
  • It does not cut or remove any haemorrhoidal tissue; hence post-operative complications are significantly reduced compared to haemorrhoidectomy
  • Since the blood-supplying arteries are not only tied off with rubber bands (which can slip and cause bleedings) but sutured, the THD procedure has been associated with far less post-operative complications and better long-term results
  • In most cases, patients resume their normal activities within 24 – 48 hours
  • After the procedure, some patients may feel a slight discomfort in the rectal area, which usually disappears within a few days.
  • If any prolapse has been sutured, some patients may feel a slight urge to defecate, which is related to the repaired prolapse and which will gradually disappear as well.
  • If any prolapse has been sutured, some patients may feel a slight urge to defecate, which is related to the repaired prolapse and which will gradually disappear as well.
  • Due to its low recurrence rates compared to traditional types of surgery, the THD procedure has been adopted in numerous hospitals throughout Europe.
  • THD is a NICE (National Institute of Clinical Excellence) recommended the procedure.
2Surgery for fistulae
Types:
  • Fistulotomy
  • The type of surgery done will depend on the type of anal fistula present. In cases where very little of the sphincter muscle is involved, a fistulotomy may be done. This involves an incision in the skin and muscle over the fistula tunnel so that it may be flushed out. This leaves the fistula open like a groove so that it may heal on its own.
  • Lateral sphincterotomy
  • If the sphincter muscles are involved, a special drain called a seton would be placed for 6 weeks to drain the fluid from the abscess. Over a few weeks, an incision will be made in the muscle. A follow-up surgery is then needed. This may be done to cover the fistula with a piece of tissue or to open and spread the sphincter muscles before tying the fistula off. In some cases, fibrin glue or a collagen plug may be advised to seal the fistula instead of opening it.
  • Surgery for rectal prolapse
  • Surgery for rectal prolapse can be done through the abdomen or through the anus depending on your specific case. When possible Dr Kavin will choose the least invasive approach and use laparoscopic surgical tools to minimise the recovery period. Under general anaesthesia, small incisions are made in the abdomen so that laparoscopic tools can be inserted. The laparoscope is fitted with a camera to allow for better visualisation while surgery is done with other small surgical tools. The rectum is then pulled back into its anatomical position and secured with sutures or a mesh sling anchored to the pelvis. If the rectal prolapse repair is done through the area around the anus, the anus is pulled through to its correct position through the anus. Part of the rectum and sigmoid may then need to be removed, and the remaining rectum reattached to the large intestine. In some cases, vaginal prolapse or pelvic organ prolapse is also present. If this is the case, you will need to have both repairs done in one surgery.
  • Surgery for anal fissures
  • Under general anaesthesia, Dr Kavin will make a small incision into the anal sphincter to release the tension. This will allow the fissure and the torn lining to heal, easing pain and discomfort.

Risks

Laparoscopic surgery is very common and generally regarded as safe. Serious complications are rare, occurring in just one in 1,000 cases, according to estimates.

Possible complications include:

  • damage to organs, such as the bladder or bowel
  • injury to a major artery
  • damage to nerves in the pelvis

As with any surgical procedure, complications may occur. Some possible complications include, but are not limited to, the following:

  • Wound infection
  • Peritonitis - Inflammation of the abdomen that can occur if the appendix ruptures during surgery
  • Bowel obstruction

There may be other risks depending on your specific medical condition. Be sure to discuss any concerns with your doctor prior to the procedure.

Hospital

Operating from the new state-of-the-art, multi-disciplinary facility equipped with only the most advanced medical technology,

Equipment

As one of only two such robots in the Western Cape, Dr Kavin operates from a hospital boasting Robotic Surgery capabilities,

Technique

As a surgeon with adept skill in minimally invasive techniques, Dr Kavin opts for laparoscopic keyhole surgery whenever possible.

Expertise

Dr Bruce Kavin is a General Surgeon with particular expertise in Endocrine, Colorectal and Gastrointestinal Surgery and Surgical Oncology.

parallax background