PROCEDURE INFORMATION

ANAL PHYSIOLOGY

Anal physiology testing or biofeedback is often required prior to any planned surgery, particularly that related to the lower rectum or anus.
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BANDING

Rubber band ligation (RBL) is a procedure where elastic bands are applied to the internal haemorrhoid at least 1 cm above the dentate line. These eventually slough off within a week. This is a painless procedure unless the band is placed too close to the dentate line. If this occurs, intense pain may result.
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BIOFEEDBACK

Biofeedback is a form of behavioural training and combined with pelvic floor physiotherapy and is often used for patients with faecal incontinence, severe constipation or the weak pelvic floor.
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BOTOX INJECTION

Botulin toxin A (Botox®) injections work by temporarily paralysing a portion of the internal sphincter muscle. Botox has the advantage of being effective in 60-80% of cases as well as being reversible and repeatable.
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BOWEL SURGERY

Bowel surgery is major surgery and is performed by specialist colorectal surgeons, and may be indicated to remove a colorectal cancer (Figure 1), or for severe diverticular disease of the colon.
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COLONOSCOPY

Colonoscopy is a simple day-stay procedure performed under sedation. It involves the passage of a flexible tube (colonoscope) about the thickness of a pen into the colon (also called the ‘large intestine’) via the back passage (anus) to allow for careful examination of the entire colon
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FISTULA REPAIR

The initial management of a fistula is to drain it. This is a small surgical procedure performed under general anaesthetic where a silastic seton (similar in size and consistency to a rubber band) is passed through the fistula tract and tied in place. This allows any pus to drain, and inflammation to settle
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HAEMORRHOIDECTOMY

Stapled haemorrhoidectomy uses a circular stapling device that removes a ring of haemorrhoid tissue and mucosa (much like a doughnut) within the upper anal canal. This has the benefit of avoiding an open wound and having less pain than an open haemorrhoidectomy (when stapler positioning is high in the anal canal). It is only suitable for internal haemorrhoids of moderate size. It is not suitable for very large haemorrhoids, or those with significant prolapse or external component.
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HAEMORRHOIDOPEXY

The Doppler-guided Haemorrhoid Artery Ligation (HAL) and Recto-Anal Repair (RAR) are both techniques which when combined result in a form of haemorrhoidopexy, where the haemorrhoids are lifted back up flat within the upper anal canal
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GROIN HERNIA REPAIR

Groin hernias can be repaired as a day-stay procedure using an open or key-hole (laparoscopic) approach. Open repair can be performed under local anaesthetic with sedation, whereas key-hole (laparoscopic) repair requires a general anaesthetic
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INCISIONAL HERNIA REPAIR

Abdominal incisional hernias are common after operations requiring a large incision. These can be at the umbilicus, above the umbilicus (epigastric) or along the full length of the incision (massive ventral hernia)
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STOMA HERNIA REPAIR

A stomal hernia (also called a para-stomal hernia) is a type of incisional hernia that occurs next to a stoma. It is a common problem, and can be challenging to manage.read more
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IMPLANTS FOR INCONTINENCE

Injectable implants may been used to seal isolated/multiple defects in the internal anal sphincter. Several agents have been used, including silicon (PTQ®) and Pyrolytic carbon-coated beads (Durasphere®).
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NON-INVASIVE SURGERY

ENDOSCOPIC SURGERY

Endoscopic Surgery is performed through a colonoscopy and is used for many colorectal conditions.
However, its main use is for large (>1cm) benign polyps of the colon that cannot be removed with conventional snare polypectomy. It should not be used for biopsy proven polyps containing cancer, or polyps with suspicious features for having cancer in them.
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KEY-HOLE SURGERY

Key-Hole surgery has the benefit of reduced size of incision, leading to better cosmesis and reduced pain. This allows for earlier mobilisation with less, pain, and earlier resumption of normal activities including earlier return to work.
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ROBOTIC SURGERY

Robotic colorectal surgery with the Da Vinci® robot, allows for the benefits of minimally invasive surgery, along with the fine precision, 3D vision and magnified view afforded only by robotic surgery.
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TEMS

Transanal Endoscopic Micro-Surgery (TEMS) allows for the removal of benign polyps of the rectum without need for conventional surgery. It has many benefits over conventional surgery, is safe, and allows for early discharge being performed as a day-stay procedure.
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PILONIDAL SINUS SURGERY

There are many operations for pilonidal sinus, indicating that none are 100% effective. Most have a success rate of greater than 90%, with wound breakdown occuring in up to 5-10% of cases
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RECTOPEXY

Rectopexy is increasing being performed laparoscopically (key hole) with benefits of small incisions and less pain than traditional open surgery. It is suitable for partial thickness and full thickness rectal prolapse.
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SACRAL NERVE STIMULATION

Sacral Nerve Stimulation (SNS) is neuro-electrical stimulation of the sacral nerves that supply the anus and rectum. It has been shown to be effective in the management of a faecal incontinence. More recently, it has been shown in a small number of studies to be useful for slow transit constipation. The exact mechanism of its action for improving
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SPHINCTEROTOMY FOR FISSURE

Relaxation of the anal sphincter may be achieved by performing a lateral sphincterotomy. In this procedure less than a third of the inner anal sphincter is divided at the level of the anal fissure, to provide relief from anal sphincter spasm to allow
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