What’s new in colon and anal surgery
Colon and anal diseases represent a major problem for people, especially in Egypt and the Arab world, and colon and anal surgeries play an extremely important role in treating patients and relieving their pain.
Is colon and anus a modern specialty ?
Colon and anal surgery is one of the oldest medical specialties in the world. The Brazilian Colon and Anal Surgery Society was established at the beginning of the last century in 1901, the American Colon and Anal Society was established in the 1950s, and the International Association of Professors of Colon and Anus was established in 1969, which indicates the antiquity of this specialty, but What is new is the diagnostic and therapeutic methods that were introduced in it, which led to a breakthrough in this specialty, which led to its restructuring and the desire of many doctors around the world to enter it, like other specialties such as blood vessels and cosmetology.
A large segment of patients with colon tumors suffer from incisions made in the abdomen (colostomy) after bypass. Is there anything new to solve this problem ?
Colostomy, which is made after diverting waste to the abdominal wall after removing parts of the colon and rectum, is one of the methods that has been less used in the last decade. This method was one of the commonly used methods and is still used in some medical centers for cases of removal of anal cancerous tumors and fistula cases. High anal. As for cases of low anal tumors, the difficulty was in connecting the colon to the anal canal after removing the tumor. We have performed surgeries for many cases suffering from low rectal tumors, either by resection from within the rectum without opening the abdomen, or from the abdomen using the colon retraction method or using Surgical staplers, through which the intestine can be connected to the anal canal while preserving the anal constrictor muscles, so that the patient can excrete normally and control the excretion process. As for the high anal fistula, it has only been scientifically proven that diverting the excretory tract to the abdomen does not close the fistula automatically, but knowing the direction of the fistula and the anatomical character of the muscles through modern diagnostic methods such as magnetic resonance imaging and three-dimensional anal ultrasound can determine the map and path of the anal fistula, and completely removing the fistula is the basis for recovery. In these cases, without diverting the stool to the abdomen.
A waste collection bag is placed around the excretory openings in the abdomen (colostomy), but what about cases of incontinence ?
Lack of control over excretion is still a chronic problem for doctors, but the reasons are many and vary from lack of control resulting from a cut in the anal muscles (as a result of a previous injury), or paralysis of the anal muscles (resulting from a disease of the lower spine), or chronic megacolon resulting from partial paralysis of the colon, which leads to To increase storage within the colon, which results in chronic constipation and then ends with lack of control over excretion, and it affects children from the age of 3 to 18 years.
What are the latest treatment methods ?
Treatment methods vary based on the precise diagnosis of the causes and any cut of the anal muscle or the nerve supplying the anal muscle or the colon. Based on the diagnosis, the treatment method is determined.
Muscle repair for cases of muscle tear usually occurs as a result of muscle tear resulting from previous surgery, such as hemorrhoids or anal fissures, or after natural childbirth in women, especially those that take place in homes and primitive centers. The child’s head is large, causing lacerations of the vaginal opening and anal muscles, unless the obstetrician and gynecologist deals with it surgically by performing a surgical expansion. With the opening of the vagina and then closing it again, this segment of patients was suffering from incontinence and lack of control over stool. Previous repair surgeries had not yielded satisfactory results due to the lack of knowledge of the anatomical character of the anal constrictor muscles. In light of medical research, in the past two decades, the anatomical and functional character of the anal constrictor region has been determined. The pelvis and anus, which led to raising the efficiency of muscle repair surgeries to between 80-90%.
As for the injury to the nerve supplying the muscle, some prosthetic surgeries can now be performed to overcome the lack of control based on the degree of nerve paralysis and muscle atrophy. In some cases, an electrical pulse stimulating device is placed under the skin to act as a nerve. Muscles taken from the leg can be implanted to perform the function of atrophied muscles, or an artificial valve can be implanted around the anal canal, but this device has special conditions for the patient. The incidence of these cases ranges from 70-80%.
As for cases of colon paralysis or chronic megacolon that affects children, there are several methods of treatment, starting from performing simple surgery in the anus to removing part of the colon. This surgery is now performed either through the anal canal by withdrawing the colon from the anus without opening the abdomen, or through a surgical laparoscope. Making small incisions in the abdominal wall.
