SERVICES AND PROCEDURES
Most umbilical hernias in babies close on their own by age 1 or 2.Your doctor may even be able to push the bulge back into the abdomen during a physical exam. Don’t try this on your own, however.
Although some people claim a hernia can be fixed by taping a coin down over the bulge, don’t try this. Placing tape or an object over the bulge doesn’t help and germs may accumulate under the tape, causing infection.
For children, surgery is typically reserved for umbilical hernias that:
Are slightly larger than 1/4 to 3/4 inch (1 to 2 centimeters) in diameter
Are large and don’t decrease in size over the first two years of life
Don’t disappear by age 5
Become trapped or block the intestine
For adults, surgery is typically recommended to avoid possible complications, especially if the umbilical hernia gets bigger or becomes painful.
During surgery, a small incision is made near the bellybutton. The herniated tissue is returned to the abdominal cavity, and the opening in the abdominal wall is stitched closed. In adults, surgeons often use mesh to help strengthen the abdominal wall.
What is hemorrhoid surgery?
Today technological and medical research has made available an alternative patient-friendly surgical treatment for hemorrhoids: Doppler procedure.
Doppler Method is an advanced surgical technique for hemorrhoid treatment, whose main benefit is keeping anorectal anatomy preserved without the removal of hemorrhoids.
During this procedure, the colorectal surgeon ligates vessels that bring arterial blood to hemorrhoids, reducing excessive blood flow. This ligation occurs in an area less sensitive to pain and is then followed by the repositioning of prolapsed hemorrhoids at their original site.
Results achieved using Doppler method have led to a growing number of surgeons offering THD to an increasing number of patients.
Tests and procedures used to diagnose appendicitis include:
Physical exam to assess your pain. Your doctor may apply gentle pressure on the painful area. When the pressure is suddenly released, appendicitis pain will often feel worse, signaling that the adjacent peritoneum is inflamed.
Your doctor may also look for abdominal rigidity and a tendency for you to stiffen your abdominal muscles in response to pressure over the inflamed appendix (guarding).
Your doctor may use a lubricated, gloved finger to examine your lower rectum (digital rectal exam). Women of childbearing age may be given a pelvic exam to check for possible gynecological problems that could be causing the pain.
Blood test. This allows your doctor to check for a high white blood cell count, which may indicate an infection.
Urine test. Your doctor may want you to have a urinalysis to make sure that a urinary tract infection or a kidney stone isn’t causing your pain.
Imaging tests. Your doctor may also recommend an abdominal X-ray, an abdominal ultrasound, computerized tomography (CT) scan or magnetic resonance imaging (MRI) to help confirm appendicitis or find other causes for your pain.
Surgery to remove the appendix (appendectomy)
Appendectomy can be performed as open surgery using one abdominal incision about 2 to 4 inches (5 to 10 centimeters) long (laparotomy). Or the surgery can be done through a few small abdominal incisions (laparoscopic surgery). During a laparoscopic appendectomy, the surgeon inserts special surgical tools and a video camera into your abdomen to remove your appendix.
In general, laparoscopic surgery allows you to recover faster and heal with less pain and scarring. It may be better for older adults and people with obesity.
But laparoscopic surgery isn’t appropriate for everyone. If your appendix has ruptured and infection has spread beyond the appendix or you have an abscess, you may need an open appendectomy, which allows your surgeon to clean the abdominal cavity.
Expect to spend one or two days in the hospital after your appendectomy.
If you have a chronic pilonidal cyst or it has gotten worse and formed a sinus cavity under your skin, it’s a serious case and you may need surgery to excise (remove) the cyst entirely. Afterward, the surgeon might either leave the wound open for packing (inserting gauze) or close the wound with sutures or a skin flap (skin taken from a healthy part of your body). Whenever you have surgery, it’s important to take good care of your wound so it doesn’t get infected. Your provider will tell you how to keep your wound clean (including shaving the area) and how long you should keep it covered. They’ll also tell you the warning signs of infection and when you should call your provider.
Treatment for an itchy anus usually first focuses on establishing good anal hygiene. Thoroughly clean your anus after pooping, dry the area and apply nonmedicated talcum powder.
If you have secondary pruritis ani, your treatment depends on the specific cause.
Treatments may include:
Antibiotics and antifungal medications
Your healthcare provider may prescribe antibiotics or antifungal medications if they suspect an infection is causing your itchy anus.
Avoid certain foods and drinks
Dairy products, carbonated drinks, caffeinated beverages and acidic or spicy foods may cause anal itching. It’s best not to avoid all of these foods and drinks at once. Gradually removing one of these items every few days can help you determine which food or drink is causing your itchy anus.
Wear cotton underwear
Cotton underwear absorbs moisture. Make sure your underwear fits properly and change it often. Use fragrance-free detergents to wash your underwear.
Your doctor may recommend:
Externally applied nitroglycerin (Rectiv), to help increase blood flow to the fissure and promote healing and to help relax the anal sphincter. Nitroglycerin is generally considered the medical treatment of choice when other conservative measures fail. Side effects may include headache, which can be severe.
Topical anesthetic creams such as lidocaine hydrochloride (Xylocaine) may be helpful for pain relief.
Botulinum toxin type A (Botox) injection, to paralyze the anal sphincter muscle and relax spasms.
Blood pressure medications, such as oral nifedipine (Procardia) or diltiazem (Cardizem) can help relax the anal sphincter. These medications may be taken by mouth or applied externally and may be used when nitroglycerin is not effective or causes significant side effects.
If you have a chronic anal fissure that is resistant to other treatments, or if your symptoms are severe, your doctor may recommend surgery. Doctors usually perform a procedure called lateral internal sphincterotomy (LIS), which involves cutting a small portion of the anal sphincter muscle to reduce spasm and pain, and promote healing.
Studies have found that for chronic fissure, surgery is much more effective than any medical treatment. However, surgery has a small risk of causing incontinence.
What are the treatments for an anal fistula?
Surgery is almost always necessary to cure an anal fistula. The surgery is performed by a colon and rectal surgeon. The goal of the surgery is a balance between getting rid of the fistula while protecting the anal sphincter muscles, which could cause incontinence if damaged.
Fistulas in which there is no or little sphincter muscle involved are treated with a fistulotomy. In this procedure, the skin and muscle over the tunnel are cut open to convert it from a tunnel to an open groove. This allows the fistula tract to heal from the bottom up.
Small rectovaginal fistulas may heal on their own over time. You may need antibiotics for infections or medications for IBD.
Most people with rectovaginal fistulas need surgery to close the opening. Your healthcare provider may use your tissue or lab-made tissue to repair a rectovaginal fistula. As many as 9 in 10 people recover completely after surgery.
If the opening is large, you may need a temporary colostomy. This procedure diverts poop (stool) away from your large intestine and rectum until the fistula heals. Stool leaves your body through a surgical opening in your abdomen called a stoma. It collects in a bag that you change regularly. You’ll need another surgery later to reconnect your intestine and close the stoma.
How do you fix rectal prolapse?
There are several surgical approaches to fixing rectal prolapse. Which procedure you have will depend on the specifics of your condition. For generally healthy adults, the first choice is usually a rectopexy, which is a procedure to repair your rectum through your abdomen. However, some people might not be good candidates for abdominal surgery. In these cases, rectal surgery is another option.
Abdominal approach (rectopexy)
This procedure restores your rectum to its original position in your pelvis. Your surgeon will attach your rectum to the back wall of your pelvis (your sacrum) with permanent stitches. They may also reinforce it with mesh. These will hold your rectum in place long enough for scar tissue to develop, which will hold it in place after that. Rectopexy has a 97% long-term success rate in fixing rectal prolapse.
Depending on the judgment and experience of your surgeon, you may have your rectopexy by either open abdominal surgery or minimally invasive surgery. Open surgery means opening up your abdominal cavity to access your organs. Minimally invasive surgery is done through small “keyhole” incisions, using a small camera, and is sometimes done with the use of a surgical robot. Both procedures are done under general anesthesia.
If you’ve had a history of chronic constipation, and if this was a contributing factor to your rectal prolapse, your surgeon may suggest a partial bowel resection at the time of your rectopexy. That means removing a section of your colon. Your surgeon can identify the part of your colon where difficulties with constipation tend to occur. Removing the problem section often improves bowel function afterward.
Rectal approach (perineal)
If abdominal surgery isn’t an ideal option for you, your surgeon may approach your rectal prolapse through your anus. Rectal surgery doesn’t always require general anesthesia as abdominal surgery does. Some people can have it with epidural anesthesia. The rectal or “perineal” approach may also be a better choice if you have a very minor prolapse, or if your rectum is stuck on the outside (incarcerated). There are two common procedures:
Altemeier procedure. In this procedure, your surgeon pulls the prolapsed rectum out through your anus and removes it. They may also remove the lower part of the colon (sigmoid colon) if it is involved in the prolapse (proctosigmoidectomy). Then they sew the two ends of your large intestine (your remaining colon and your anus) back together. The new end of your colon now becomes your new rectum.
This procedure is less invasive than open abdominal surgery and easier to recover from, but its disadvantage is that prolapse may recur afterward. One reason is that the new rectum made from your colon is not as strong as your original rectum was. Because of this, some surgeons combine the altemeier procedure with a “levatoroplasty” — tightening the pelvic floor muscles by sewing them closer together.
Delorme procedure. If you only have a mucosal prolapse, or a small external prolapse, your surgeon may choose a more minor procedure. The Delorme procedure only removes the prolapsed mucosal lining of your rectum. Your surgeon then folds back the muscle wall of the rectum onto itself and stitches it together inside your anal canal. The double muscle wall helps to reinforce the rectum.
Mild rectoceles may be managed with pelvic floor exercises to strengthen your pelvic floor muscles. Your healthcare provider may also recommend a pessary. A vaginal pessary is a removable device inserted into your vagina to support prolapsed organs.
With moderate to more severe prolapse, your healthcare provider may recommend surgery to repair the rectocele. You may discuss the following with your provider to determine the right procedure:
Your age and general health.
The degree of your prolapse.
Your desire for future pregnancies.
Your wish to continue having intercourse (one surgery for POP called colpocleisis seals your vaginal opening).
A surgical procedure called posterior colporrhaphy is commonly used to repair rectoceles. During the procedure, your provider removes damaged tissue that’s no longer supporting your pelvic organs and sutures the healthy tissue together for added support.
Often, your provider performs rectocele surgeries through your vagina, an approach that leaves no scars.