Minimally invasive surgery in proctology in Kharkiv

The use of minimally invasive surgery techniques in proctology allows the patient to be relieved of the manifestations of the disease in a short time and with minimal tissue trauma. Minimally invasive surgeries are characterized by a low risk of postoperative complications and a short rehabilitation period, so within a few days the patient can get back to the usual life.

Diagnostics of pararectal fistula

A pararectal fistula is a pathological opening, a cavity in the subcutaneous fatty tissue of the perianal region (anus). A pararectal fistula (fistula) is often a consequence of acute paraproctitis, a purulent inflammation of the tissues surrounding the rectum.

Anal fistula is characterized by the presence of fistulous tract starting inside the rectum and ending with an external opening in the anus or perineum. Fistula formation is caused by gradual destruction of the tissues of the rectal mucosa and pararectal tissue due to the inflammatory process.

The main causes of the development of pararectal fistula include:

• acute paraproctitis;
• injuries and cracks in anus;
• chronic constipation with formation of hard feces;
• inflammatory bowel diseases (Crohn’s disease, proctitis and others);
• hemorrhoids;
• tuberculosis;
• difficult labor with rupture of the birth canal;
• diverticula (pathological protrusion of wall) of rectum;
• infectious and venereal diseases (chlamydia, syphilis, actinomycosis, etc).

Chronic adrectal fistula is accompanied by pain in the anal region, the release of pus from the opening, a regular increase in body temperature and rapid fatigue. Diagnosis of a pararectal fistula begins with examination of the patient by a proctologist. The doctor finds the external opening of the pathological canal, and then palpates (probes) the soft tissues along its course to identify abscesses. The proctologist then performs a digital or specular examination to assess the condition of the anal ring.

Other methods for diagnosing rectal fistulas include the following:

• probing - the examination allows to determine the fistula depth and the presence of additional branches in it;
• sigmoidoscopy - visual examination of rectum and sigmoid colon using a special probe equipped with a miniature video camera and illumination. Sigmoidoscopy allows to determine the internal opening of fistula;
• transrectal ultrasound of soft tissues - the examination makes it possible to see the fistula and assess its location in relation to the rectum;
• test with methylene blue - the introduction of a dye into the fistula allows to determine its internal and external holes, as well as reveal hidden pockets;
• fistulography - X-ray examination of fistulous passage with the introduction of a contrast agent into it.

Women should be examined by a gynecologist to rule out the presence of a vaginal fistula. Laboratory tests (blood tests, urine tests) in case of diagnosing the pararectal fistula are referred to assess the severity of inflammation in the body. Bacteriological culture of secretions from the external opening of the fistula is prescribed to determine the type of infectious agent and the choice of antimicrobial drug.

Procedure of pararectal fistula excision 

The only treatment for pararectal fistula is its surgical excision. During the operation, spinal anesthesia is used (an injection of anesthetic in the back, after which the lower body becomes insensitive) and intravenous sedation.

Stages of surgical excision of pararectal fistula:

1. The surgeon injects a dye (1% methylene blue solution) into fistula to visualize the pathological course.
2. Then the fistula is excised and the pockets with purulent contents are cleaned.
3. The doctor sutures the sphincter and closes the internal opening of the rectum by moving the mucous membrane.

The operation takes from 30 minutes to 1 hour. After its completion, the patient is transferred to the ward, where he/she stays for 1-2 days, and then is discharged home. 

Surgical excision of pilonidal cyst

Pilonidal cyst (epithelial coccygeal passage) is a congenital pathology characterized by the presence of a capsule under the skin in the coccyx region, the outlet holes of which are located in the midline between the buttocks (6-10 cm above the anus). Pathology is diagnosed mainly in men under the age of 30.

Sebaceous gland secretions, particles of dead skin and hair gradually accumulate in the capsule. This creates a favorable environment for the bacteria growth, which penetrate into the cavity and cause inflammation. Due to tissue edema, the exit holes of the pilonidal cyst of the tailbone are blocked and pus accumulates inside it, which leads to the abscess development.

The main symptoms of pilonidal cyst:

• painful sensations in the gluteal fold, aggravated by movement;
• redness, swelling of the skin above the coccyx;
• pain when sitting;
• presence of purulent discharge from the cyst outlet channels;
• visible swelling in the lower back;
• increased body temperature. 

The only treatment for pathology is a surgical operation to remove the pilonidal cyst. It is performed under spinal (epidural) anesthesia with intravenous sedation.

Stages of surgical excision of the pilonidal cyst:

1. The fistulous course of the pilonidal cyst is stained with 1% methylene blue solution.
2. The cyst is excised in a single block.
3. The wound is closed with cosmetic stitches.

The operation takes about 1 hour. After surgical removal of pilonidal cyst, the patient is in the hospital for 1-3 days and then is discharged home.

Preparation for proctological operations

Preparation for proctological operations begins with a consultation by a proctologist. After the examination, the doctor refers the patient to the necessary additional diagnostic tests. At the second appointment, as a rule, the date of the surgical intervention is already assigned. The patient should not eat the night before and on the day of the operation, and two hours before the operation should not drink.

If you need surgical treatment of proctological diseases using minimally invasive techniques, make appointment for a consultation by a proctologist surgeon at the medical center “ON Clinic Kharkiv”. Leave a request on the website or call the specified phone number.