The main manifestations of colorectal diseases include:
- feeling of discomfort, 'foreign body' in the rectum and anal canal;
- pain and burning during and after defecation;
- pathological discharge from the rectum (blood, mucus, pus);
- bowel movement difficulty;
- itching in the anal region;
- formations in the anal and sacrococcygeal region;
- constipation, diarrhoea; and
- tympanites.
Diagnosis of colorectal diseases
According to statistics, colorectal disorders occur in every second adult. Due to the sensitivity of the problem, the patient does not always visit the doctor with minor symptoms. A timely consultation with a coloproctologist will make it possible to identify the disease at an early stage and start treatment immediately. That will speed up the recovery process and prevent surgical treatment in some cases.
An appointment with a coloproctologist begins with a detailed history taking (complaints, comorbidities, lifestyle and dietary habits). A colorectal examination is carried out either in the position on the left side with the legs brought to the stomach or on the gynaecological chair. The doctor conducts a digital rectal examination as sparingly as possible. It allows diagnosing up to 80% of the pathology of the anal canal and rectum. Anoscopy is also conducted. That is examination of the anal canal and lower part of the rectum using a special device, anoscope. If medically required, laboratory and endoscopic examinations are organised. The latter include sigmoidoscopy and video colonoscopy. Ultrasonography, MRI and CT can also be carried out.
In our Clinic, minimally invasive methods of treating colorectal diseases are practiced at our day patient department located in the Centre for Outpatient Surgery at 3 Tsiolkovskogo Street.The following diseases can be treated there:
- haemorrhoids of various stages and their complications (thrombosis or bleeding);
- acute and chronic anal fissures;
- rectal fistulas;
- anal tags;
- anal polyps;
- warts, papillomata, lipomata, fibromata in the anal canal and perianal region; and
- inflammatory diffuse lesions of the rectum (proctitis or proctosigmoiditis).
The treatment at the Centre for Outpatient Surgery begins with the patient's first visit. The doctor chooses a diet, suggests how the patient's lifestyle should be changed, prescribes drug therapy and local treatment.
If the patient requires surgical treatment, they have to undergo an examination prior to the surgery in order to be admitted to surgical treatment. At the Clinic, an examination before the surgery can be carried out on an urgent basis. The doctor draws up an operative plan at the consultation, after discussing all the options of treatment with the patient. Surgeries at our day patient department are performed either under local anaesthesia or under total intravenous anaesthesia.
The type of anaesthesia is determined before the surgery by an experienced anaesthesiologist, depending on the volume of intervention and the patient's condition. At the early stages of the disease, different methods of treatment can be used (sclerotherapy, infrared photocoagulation, ligation, submucosal laser destruction, treatment with a special laser, possibly using the LigaSure device). After the surgery, the patient is sent to the comfortable wards of the day patient department and post-surgical awakening department.
Laser proctology
Laser treatment of colorectal diseases is one of the lines of coloproctologists' effort. Laser can help in the treatment of chronic and acute haemorrhoids, anal fissures, rectal fistulas, anal polyps and pilonidal cysts. If there are complaints of: discomfort, pain or itching in the anal canal; arterial bleeding after defecation; or prolapsed nodes the patient can contact the specialists at our Clinic in order to be accurately diagnosed and assigned the most appropriate therapy.
The diagnosis is made only after an examination. Then, further investigations are discussed with the patient (if necessary − sigmoidoscopy, colonoscopy, ultrasonography, MRI), as well as treatment options, both conservative and surgical.If a surgery is still required, our doctors will offer the best option for this particular case. Many techniques are minimally invasive and can be performed on an outpatient basis.
In our Clinic, the following procedures are conducted using a special laser:
- laser coagulation of haemorrhoids;
- laser excision of anal fissures;
- laser closure of rectal fistulas; and
- laser excision of haemorrhoidal tags and formations in the perianal region.
The advantage of laser technology:
- The operation takes a short time (about 30 minutes).
- The local effect on the mucosa takes place only in the affected area, without affecting healthy areas.
- The pain syndrome after such procedure was assessed by patients on the VAS scale (visual analogue scale) as 45 points (mild and moderate pain). That corresponds to the global statistics. The pain syndrome stopped completely after taking non-steroidal anti-inflammatory drugs.
- Patients go home 23 hours after the procedure.
- The post-operative period proceeds with a low risk of complications.
- Short terms of rehabilitation (about 2 weeks, depending on the volume of intervention).
- Wounds in the anal area after the intervention heal without gross cicatricial changes.
- If required, you may consult other specialists at the Centre for Outpatient Surgery (therapist, gastroenterologist, neuropathologist, gynaecologist, urologist, etc.).
HAL-RAR surgery
Haemorrhoids is a widespread disease that has grown epidemic during the recent decades. Large contingents of people of working age are exposed to haemorrhoids. This leads to the loss of a significant number of working days, thus making haemorrhoids one of the general medical and socio-economic problems that need to be addressed.
Doppler - guided haemorrhoid artery ligation with lifting and mucopexy of the anal mucosa (HAL-RAR surgery)For quite a long time, the main method of surgical treatment was traditional haemorrhoidectomy (Milligan-Morgan surgery or its modifications). It does not provide a short rehabilitation period after the surgery. The average recovery period after such an intervention was more than a month.
In recent decades, the search for a solution to this problem has led to the emergence of new methods of surgical treatment using electrosurgical instruments (haemorrhoidectomy using a laser, a LigaSure device, an ultrasonic scalpel, etc.). However, even in these cases, the rehabilitation period was still long.
A completely new approach to the treatment of haemorrhoids, in accordance with modern ideas about their anatomical and pathogenetic aspects, is transanal Doppler-guided haemorrhoid artery ligation with lifting and mucopexy of the anal mucosa (HAL-RAR surgery). It was first described in 1996 by the Japanese scientist Kasumaza Morinaga. The principle of this method is to ligate the terminal branches of the superior rectal artery that feed this anatomical region and participate in the formation of haemorrhoidal vascular cavities with mixed blood supply, commonly called 'nodes', and perform the so-called lifting and mucopexy of protruding haemorrhoid nodes.
This approach has a number of advantages:
- elimination
- of the underlying cause of the disease, i.e. a reduction of the pathological inflow of arterial blood to the internal haemorrhoidal plexus and fixing the node in a physiological position;
- absence of post-surgical wounds;
- relatively short intervention time;
- the ability to start working in 2 or 3 days;
- the possibility of performing the intervention under any type of anaesthesia;
- the possibility of performing the procedure in combination with other methods in case of a combined pathology of the anal canal (a fissure or a fistula); and
- little painful or painless post-surgical period.
In conclusion, it should be noted that this method:
- is a pathogenetically substantiated procedure that makes it possible to restore the normal anatomy of the anal canal in the shortest time possible;
- is a significantly less traumatic manipulation compared to closed haemorrhoidectomy;
- and an ideal one-day surgery solution meeting the minimal aggressiveness requirements.