Advances in colorectal surgery

Which are the anal diseases with more incidence?

The anal diseases with more incidence are basically the anal fissure, the hemorrhoids and the anus fistula. Yes it is true that in this specialty there are many more diagnoses but the three major groups are the patient with anal fissure pain, the patient with blood or prolapse derived from hemorrhoids or the patient with an infectious process, anal fistula type either by an abscess or a communication between the anus and the outside of your perineum.

In the last years that advances have taken place in the treatment of this type of pathologies?

In these three pathologies there have been different attempts to improve this treatment. In the anal fissure, for example, nitroglycerin ointments have come out, which were tested from around 2005, and that initially seemed an important advance in the treatment of anal fissure but later we saw that these patients we had to operate them as if they had not taken nitroglycerin. In fact, in 2010, a multicenter work at a European level showed that nitroglycerin greatly relieves patients but does not cure them in a decisive way.. After one year, the number of patients we had to operate was very similar to that of patients who had not taken nitroglycerin.

In the field of anus fistula there have been advances in the treatment of more complex fistulas, less complex fistulas continue to be treated in a classical manner, with the fistulotomy that a wound remains and then the patient gradually heals. But with complex fistulas, to try to section less and less sphincters with this surgery, we have devised different systems, for example the glue that is like a kind of glue that is put through these fistulous paths, even the laser of the fistulous orifices , the advance flap to advance a mucosal orifice that will cover the internal orifice of these fistulas. But all these procedures, apart from classic fistulotomy, do not have an equal success rate. Yes it is true that in many cases we have no other solution than to use this other type of surgery or procedure to try to tackle this fistula problem without severing much of the sphincter mechanism.

In the field of hemorrhoids, progress has been made in the matter using the Doppler, which is a system to locate the vascular flow of these three groups of veins that we have in the anus, which are hemorrhoids, and then practice a ligature or suture of this vascular pedicle. Despite this we have to keep saying that classic hemorrhoidectomy is the most effective and most definitive treatment for hemorrhoids at its maximum stage, in stage 4. Yes it is true that in earlier stages we continue using the bands, which consist of a ligation of internal hemorrhoids to stop maintaining the two important symptoms that are bleeding and prolapse, meaning that the patient notices that there is something that goes through his anus. And basically these are the advances, there have not been very important advances in these three pathologies.