Proctoplasty

Proctoplasty is the plastic surgery of the anus or rectum. Reconstructive surgery and anaplasty are other broader terms for proctoplasty. Proctoplasty is performed predominantly on children born with ano-rectal anomalies. There are cases born without any opening at the anus. Congenital fistulae may be present in some infants. Surgery alone affords cure to cases of this nature. While cases born without any opening at the anus are treated as an emergency procedure, fistulae treatment can be delayed for about two to three years. For these cases, proctoplasty is an operation of choice, whenever possible.

Proctoplasty is also at times done during hemorrhoidectomy. Proctoplasty extends the removal of tissue higher into the anal canal so that redundant anal lining is also removed. Recently, transanal endoscopic assisted proctoplasty, which is considered as a safe procedure is adopted for anatomical reconstruction of the anorectum. In significant proportion of patients, it is also used for contemporaneous closure of the sigmoidostomy with imperforate anus without fistula. This is a novel surgical approach with less potential associated complications.

Hemorrhoids

Hemorrhoids or piles are caused when the veins around the anus or lower rectum get swollen and inflamed. Hemorrhoids are painful but surely not dangerous or life threatening. Hemorrhoids are very common among pregnant women. The pressure of the fetus on the abdomen and hormonal changes affect the blood vessels and force them to enlarge. These vessels experience severe pressure during childbirth thereby making hemorrhoid a common occurrence in women.

Causes for hemorrhoids

• Straining too much to pass stools
  
• Sitting for too long
  
• Chronic constipation
  
• Pregnancy
  
• Childbirth
  
• Obesity
  
• Cigarette smoking
  
• Excessive coughing
  
• Aging
  
• Diarrhea
  
• Anal intercourse
  
• Hypertension
  
• Lifting heavy weight
  
  

Types of hemorrhoids

Internal hemorrhoids: Veins that get swollen inside the anal canal are referred to as internal hemorrhoids. Internal hemorrhoids are not very painful as there are no pain receptors in this area. Most people who have internal hemorrhoids are not even aware. Internal hemorrhoids can bleed when they are irritated.

External hemorrhoids: Veins that get swollen near the opening of the anus are termed as external hemorrhoids. These hemorrhoids are at times painful and cause swelling and irritation.

Anal fissure: A thin tear in the anal area is an anal fissure. This hemorrhoid is itchy, painful and bleeds while passing stools.

Prolapsed hemorrhoids: These hemorrhoids are a type of internal hemorrhoid and they stretch down until they protrude outside the anus. This type of hemorrhoid can be painful.

Thrombosed hemorrhoids: A blood clot forms inside the external hemorrhoid thus causing thrombosed hemorrhoid. This type of hemorrhoid is very painful and can be felt as a stiff but tender mass in the anal area.

Typical symptoms of hemorrhoids include rectal pain and itching. There might bleeding during bowel movements. Increase fiber and fluid intake to avoid constipation. Use ice packs for relief. Use hemorrhoidal cream. Tub or sitz baths can provide relief. Exercise regularly and wear loose undergarments.

Common techniques followed in removal of hemorrhoids

Hemorrhoidectomy: At times severe internal or external hemorrhoids may require removal by surgery; this procedure is known as hemorrhoidectomy.

Sclerotherapy: A chemical solution is injected around the blood vessel so as to shrink the hemorrhoid.

Rubber band ligation: A rubber band is positioned inside the rectum around the bottom of the hemorrhoid. The band helps in cutting off blood circulation thereby forcing the hemorrhoid to wither away after a few days.

Infrared coagulation: A special device is used to burn hemorrhoidal tissue.

Laser coagulation: This is a new technique - electric current is applied to remove the hemorrhoids.

Rectoplasty

Reconstructive surgery of the anus / rectum or the terminal part of the intestine is termed Rectoplasty. Rectoplasty is a surgery concerned with therapeutic and cosmetic reformation of tissue. The goal of Rectoplasty is to restore the form and function in deformed body structures which may be damaged due to various factors including disease, congenital anomaly, tumor, trauma or infection. Rectoplasty is employed not just for aesthetic problems and corrections, but also for anatomical and physiological irregularities. Vertical reduction rectoplasty has been devised specifically to correct physiological abnormalities which are present in the rectum of patients with idiopathic megarectum. Posterior sagittal ano-rectoplasty is adopted to rectify the malformations in infants, especially in females where the vestibular fistulae is frequently underestimated.