Management of Rectal Prolapse, and Common Anorectal Conditions

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Management : Chronic Fissure Botulinum toxic (botox) injection More effective than GTN ointment and withoutmajor complication (level 2 evidence)Dosage‣ 15-20 units (0.15-0.2 c.c.) properly diluted andinjected at 2-3 sites (at int. sphincter on eithersides of fissure) in divided dosesHealing rate‣ 80-90% at 8 weeksRecurrence rate‣ 10%Limitations‣ Expensive; development of antibodies; ? atrophy ofEASSecond line agent Other agents Ditialzam (Ca + blockers), nifedipine ointment
Surgery for Persistent or RecurrentFissure After Medical TherapyAnal stretch Obsolete because unacceptablyrisk (level 1 evidence)high incontinenceGold standard Left lateral subcutaneous internal sphincterotomyPreop work-up ▬ manometry (baseline)Technical points Crushing technique Divide up to length of fissure or dentate line Excisionskintagof associated hypertrophiod papilla andNo sutureCaution‣ Women have shorter anal canal Superior to botox in terms of healing rate (95%)and recurrence rate (< 5%) (level one evidence) Limitation Flatus incontinence (5%) Faecal incontinence (
Page 2 and 3: Rectal Prolapse
Page 4 and 5: Aim of Treatment Primary objectiveE
Page 6 and 7: Elective Presentation :Operative Tr
Page 8 and 9: Perineal Procedures :Delorme Proced
Page 10 and 11: Abdominal Procedure Rectopexy Sutur
Page 12 and 13: Abdominal Procedure :Sutured Rectop
Page 14 and 15: Abdominal Procedure :A ComparisonPr
Page 16 and 17: Choice of Operation :Individualized
Page 18 and 19: Haemorrhoids
Page 20 and 21: Hemorrhoidectomy Preop. preparation
Page 22 and 23: Advantages(Level 1 Evidence) Less p
Page 24 and 25: Limitations Insufficient data for g
Page 26 and 27: Management ofThrombosed Hemorrhoids
Page 28 and 29: Anal Fissure
Page 30 and 31: Assessment in the Clinic P/E Gentle
Page 32 and 33: Treatment ▬ Principles Self-perpe
Page 34 and 35: Management : Chronic Fissure Conser
Page 38 and 39: Management of Anal Fissure Acute fi
Page 40 and 41: Anal Fistula
Page 42 and 43: Classifications Park’s Classifica
Page 44 and 45: Assessment in Clinic Simple or comp
Page 46 and 47: Keys to Successful Surgery Assess t
Page 48 and 49: Complicated Fistulae Fistula with m
Page 50 and 51: Investigations Define the anatomy A
Page 52 and 53: Endoanal USG 7MHz - 10MHz rotating
Page 54 and 55: Principles Eradicate fistula pathol
Page 56 and 57: Seton Drain pus (draining seton) Ma
Page 58: Thank You!

Management of Rectal Prolapse, and Common Anorectal Conditions

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