Proctology

Laser Proctology Case – Chronic Piles Surgery and quick recovery

This is a case of 21 year old male who had complaint of bleeding per rectum for more than 2 years. Got partial relief with oral laxatives and few ayurvedic tablets. Since 6 months he started having pain while defecation with increasing chronic constipation.

Piles Surgery-laser proctology (3)

He also had occasional bleeding. He was treated with liq. Crimaffin, Anovate ointment, seitz bath with partial relief. So decided to go for surgery.

Proctology Laser for piles

Surgery was done recently by Dr Shrenik Vaidya (MS-General Surgeon) and was discharged on very next day. Proctology Laser has been used effectively in the entire procedure.

He started to work and attend his factory from the very next day.

Piles Surgery-laser proctology (5)

Post operatively he had little bleeding in dressing and while passing stool and little tolerable burning pain which was being taken care by simple analgesic. For last few days he has not taken any analgesic, no bleeding and passing stool normally.
He is very happy with results.

Doctor’s Profile

Dr Shrenik Vaidya MS General Surgeon

I am Dr Shrenik Vaidya MS General Surgeon practising for more than 25 years in city of Vadodara, Gujarat. I am in to field of Thoracic, Trauma and General surgery in addition to stem cell therapy for incurable diseases. For last 1 year I am using laser for proctology in different cases of different degrees of piles, fissure in ano, pilonidal sinus with great results.

 

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Use of Proctology Laser in Fistula

Anal fistula is a small tunnel, which connects an infected cavity in the anus or an abscess, to an opening on the skin around anus. Inside the anus, there are numerous glands which are responsible for creating fluids. When these glands and abscesses get clogged due to:

  1. Trauma
  2. Crohen’s disease
  3. Tuberculosis
  4. Radiations of chemotherapy related to cancer
  5. Sexually transmitted diseases
  6. Diverticulitis

It results in Anal Fistula.

fistulas- described by graphics

There are lot of ways through which it can be diagnosed. Usually, it involves looking for the fistula track, how deep it is and in which direction it is going. In lot of cases, there is drainage from the external opening.

Some fistulas are not visible on the skin surface. In that case, it will include some other tests like anoscopy and ultrasound or MRI of your anal area.

Surgery is a necessary solution with the goal of maintaining the balance between getting rid of the fistula while protecting anal sphincter muscles, which can cause fecal incontinence if damaged.

There is another technique that can also be used to cure it, which is laser closure. In this, a diode laser emitting laser of 12W at a wavelength of 1470 is used.

Use of Proctology Laser is considered more beneficial than normal surgery because conventional methods take lot of time. And the pain during these surgeries is quite high with considerable blood loss. That is why Laser Treatments for Fistula have emerged as a boon to the patients. It provides speedy recovery to the patient. Not only that, there is no chance of cross-contamination and it offers versatility.

Patient doesn’t need to go to the doctor’s office for frequent visits. It also provides excellent cutting and coagulation by limiting thermal damage to the surrounding tissues which leads to reduction in post-operative pain.

Laser treatments are less invasive and are less complicated. They are affordable and provide a sense of satisfaction to the patients.

Proctology Laser for fistula

Laser treatment with fistula offers several benefits over conventional surgery.

For simple fistula tract only proctology laser can be used at 12 W power delivering 100 joule /cm to close the tract.

In case of Complex fistula, Laser is used in combination with Closing the internal opening with suture and lower end of fistula can be lased.

This combination method not only yields better results but decreases the chances of Reoccurrence, post-operative pain and healing.

Proctology Laser for Fistula

In Ano rectal surgery, surgeons can choose 980nm, 1470nm or 980nm + 1470nm ( combination) wavelength to operate.

980nm wavelength preferably works on pigment while 1470nm works effectively in water and combination is used to target all three chromophores( Haemoglobin, Melanin & water).

So, in the conclusion, Laser operations are the best methods that can be used for curing anal fistula and have better healthcare.

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Hemorrhoids, anal fissures, and various anorectal fistulae are benign anorectal disorders that cause serious problems for many people in our nation. According to certain western studies, more than 80% of people worldwide experience benign anorectal problems at some point in their lives.
These ailments are all as old as human civilisation itself.

PROCTOLOGY LASER

Hemorrhoids, fissures, and fistulas continue to have a substantial influence on patients’ lives and are frequently encountered in clinical settings across specialties as benign anorectal illness. While anorectal abscess and fistulas are primarily treated surgically, haemorrhoids and fissures generally respond to non-operative care but occasionally necessitate surgery.

Surgeons around the world are still struggling to provide the best surgical treatment of these anorectal conditions. All these diseases are blamed for its recurrence even when the surgery is done in highly specialized centers. Some procedures increase the morbidity especially when aggressive surgical.

Procedures are attempted, i.e. incontinence after fistula surgery, large perianal wound in sinus tract excision. Role of many non-surgical methods in treating benign anorectal diseases to reduce the morbidity is well established. Injection sclerotherapy and banding in hemorrhoids, set on in fistula etc. are still in use.

Vital Lase - P (15W-980nm)-HD-980nm wavelength 

Diode laser in Proctology offers various benefits over any day to day treatment. Diode laser offers versatility, multifunctional equipment which is portable and require minimum maintenance.

Proctology laser-1470nm

How to choose Proctology Laser for your practice

Diode laser can be used for Laser tissue ablation, sterilization, coagulation and soft tissue cutting.Now there are several diode laser manufacturers and suppliers in market. How to choose laser for your practice and how to calculate the recurrence cost & maintenance cost of the machine.

  1. Tough & Sturdy machine remain stable in Indian harsh condition without any thermal breakdown.
  2. No fiber locking system
  3. Low reoccurrence cost for disposable item
  4. Service should be readily available
  5. Wavelength available in market are 980nm , 1470nm , 980nm + 1470nm
  6. Spare parts availability
  7. Technical support
  8. Diode capacity should be always more to increase life of machine.
  9. Optical fiber cable with radial and conical tips are mostly used in 4-5 patients maximum, remaining fiber can always be utilized as bare fiber for other treatments.
  10. Laser machine should be calibrated after using it for 2 year followed by once in a year.
  11. Updated software so that laser can be used in various department like, EVLT, lipolysis, PLDD, LVR, ENT.

Benefits of using Diode laser in proctology

  1. Day care treatment
  2. Minimal anesthesia
  3. No chance of cross infection
  4. Minimal invasive surgery
  5. No scar
  6. No post- operative discomfort
  7. Faster recovery
  8. No side effect
  9. Least reoccurrence
  10. Fewer visits to doctor after visit
  11. Anal sphincter action is well preserved
  12. Low risk of prolapse

  In case of preset parameter in most of machine, power delivered and energy is mostly set.

This works on formula

     P = E/T   

Power ( watt)

Energy ( joule )

Time  ( Sec)

 

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How LASER haemorrhoidoplasty has been done effectively?

(Case presentation on LASER haemorrhoidoplasty by Dr Sadiq Kazi)

Patient  aged 72 years male having bleeding per rectum since 5 years once or twice in a week…having prolapse since 2 years which he has to reduce manually…no other comorbid conditions….routine preoperative investigations are well and patient  was given fitness by physician…

Surgery was done under pudendal septa block with sedation..

First of all sigmoidoscopy done to confirm diagnosis and to rule out any other comorbid conditions

Supplying artery at apex of each pile mass identified and finger guided haemorrhoidal artery ligation FGHAL done with vicryl 2.0 figure of 8 stiches..

laser proctology-haemorrhoidoplasty

Done at 3,7,11 o’clock position..

Then conical laser fibre used… entered pile mass from mucocutenious junction..

Delivered energy at 8 Watts which is preset in IMDSL Laser machine…total 110 Jules of energy given to each pile mass…at 3 and 11 o’clock position at 7 o’clock only 1 degree hemorrhoid did not required it as ligation of supplying artery will be enough..

Ice pack was kept for 30 seconds after energy at each pile mass respectively..

Total operative time was 11 minutes…patient  was shifted in wheelchair…and started orally within one hour..

Post operative effect- laser

Patient was discharged after four hours of surgery…and has started his routine job from very next day as he owned a provision store…

Advice on discharge was given…to take care constipation vigorously with help of dietary modification and medication…may suffer bleeding per rectum occasionally and may also suffer mild prolapse for next 4 to 6 weeks…also explained about 10 to 12 percentage of recurrence..

 

Laser Hemorrhoidoplasty

Laser Hemorrhoidoplasty is a relatively new procedure for hemorrhoid treatment in which the haemorrhoidal blood flow is coagulated by the laser. Prior to procedure, patients need to be anesthetized by the anesthesiologist. Subsequently, the procedure will be conducted by the coloproctologist / colorectal surgeon; the laser probe will be inserted into the hemorrhoids. Due to an intense amount of heat, the laser beam cauterizes and seals off the blood vessels, therefore the hemorrhoid will simply shrink while reducing the risk of excessive bleeding during and after the procedure. Since laser Hemorrhoidoplasty is a precise procedure, it leaves no effect to the surrounding tissues as well as the anal sphincters. Benefits of using laser in this case

  1. Minimal anesthesia
  2. Same day discharge
  3. Faster recovery
  4. Instant shrinkage of pile mass
  5. Minimal or no Blood loss
  6. No cross infection

 

About Author

image of Dr.M.SADIQ KAZI

Dr.M.SADIQ KAZI is practising Laproscopic and Proctologist surgeon at his own hospital PESHANT HOUSE HOSPITAL paldi Ahmedabad.He has done his M.B.B.S and M.S from Government Medical College Surat. He has started his practice as general and Laproscopic surgeon in 2000.Gradually he developed his interest and practice in proctology field. He learnt his skills from stalwarts in this field like Dr.Pravin Kumar Gupta-Nagpur, Dr.Shanti Kumar Chivate -Thane,, Dr.Parvez Shaikh -Mumbai…

He is keen to practice in proctology by Minimal invasive way. So patient will have very smooth fast recovery and minimum morbidity.He was first in Gujarat to start Chivate surgery for rectal prolopse.
He was the first in Gujarat to start sphincterolysis in fissure in ano
He is one of the few started using LASER in Gujarat.
He has a wonderful track record in treating recurrent fistula in ano.
He has trained many doctors in proctology field.

 

 

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