Hemorrhoid diseas: DescrizionePiles (hemorrhoids) constitute the most common proctologic disease. In fact, it's estimated that, in the industrialized countries, around 50% of the population aged over 50 suffer, or have suffered from recurrent hemorrhoid problems. The high incidence of piles and the non-specificity of the clinical symptoms need a precise differential diagnosis, in order to exclude other disease of the lower GI tract, in particular the tumors.
The treatment of the hemorrhoid disease should be guided by an accurate clinical evaluation: nowadays it is possible to choose among a wide range of different treatments according to the severity of the disease and symptoms: from the conservative treatment (diet, lifestyle, topic oral treatment), to the outpatient procedure, to the different surgical options
The Hemorrhoid plexus is a physiological fibro-vascular structure, located in the lower part of the rectum and in the anal canal. These specialized vascular formations allow for the enlargement of the hemorrhoidal cushions that help maintain fine continence. These specialized vascular structures allow for the enlargement of the hemorrhoid cushions that help maintain fine continence, in fact, it is now suggested that the vascular filling contributes from 15 to 20% of resting anal pressure.
The anal cushions appear in right anterior, right posterior and left lateral position.Fistulotomy : The median age of the patients was 41 (range: 18-70). Of the 47 patients, 15 had surgery previously for fistula and perianal abscess. At least two setons were inserted through each fistula. One was tied tightly to function as a cutting seton and this was sequentially tightened by the patient and another was tied loosely for drainage. Of the 47 patients, 33 (70%) had the placement of setons in the clinic without any anaesthesia.
The remaining 14 patients had the setons inserted in the operating room, with one patient having a complex anal fistula and 13 patients having perianal abscess requiring drainage at the same time. There were no post procedure complications in the series. Forty-one patients had completed follow up at clinic within a median duration of 15 weeks (range: two to 67 weeks). The fistula was completely healed by this method in 37 patients (78%). The median healing time was nine weeks (range: four to 62 weeks).
One patient developed recurrent fistula and was healed after another seton placement. No patient developed any faecal incontinence and all patients were satisfied with this treatment. Fistula-in-ano is a common perianal condition that is associated with appreciable morbidity and inconvenience to the patient. The morbidity increases with the more complex or high type of fistulae. The most notable classification of fistula type is by Park's and this is based on the relationship between the fistula track and the anal sphincters
The principles of anal fistula surgery are to eliminate the fistula, prevent recurrence and preserve sphincter function. Success is usually determined by identification of the primary opening and dividing the least amount of sphincteric muscle possible. Most of the anal fistulae have been conventionally treated by either fistulotomy or fistulectomy, which have proven to be effective. However, the procedure requires local, regional or general anaesthesia. Post-operative wounds are usually left open and take much time to be completely healed through secondary intention.
Furthermore, there exists a noticeable risk of recurrence and incontinence especially in high risk patients with complex or high fistulas, women with anterior fistulas and elderly patients. Setons have been used to manage anal fistula for hundreds of years. In the literature, setons were commonly described only for the high or complex anal fistula in order to avoid faecal incontinence and recurrence. The usage of this method was deemed cumbersome and too slow.