Anal fissure

Anal fissure is caused by anal injuries. The major cause of anal fissure is constipation. When patients force hard stool out of the anus, the extreme pressure will tear the epithelium of the anus. Symptoms of anal fissure include fresh blood on stool and sharp pain during defecation. Besides, recurrent anal fissure will lead to ulceration around the anus, forming hypertrophic polyps and skin thickening, eventually leading to stenosis of the anal sphincter. This is a vicious cycle that makes defecation even more difficult.


 



 




Treatment of anal fissure

The treatment is targeting on the fundamental problem - constipation. Patients are encouraged to do more exercises and maintain a healthy diet, as well as using prescribed medications to soften the stools.

If the above methods failed, doctors may consider sphincterotomy, which dilates the anus and allow the wound to heal itself. Over 90% of patients recovered in 6 weeks.

Another method is called chemical sphincterotomy, in which a muscle relaxant (e.g. Botox) will be injected to the diseased area. 96% of patients recovered in 8 weeks.

 

 Reference: psclinic.com.hk/

The information aims to provide educational purpose only. 

Anyone reading it should consult Surgery Specialist before considering treatment and should not rely on the information above.

Haemorrhoid treatment (2)

Traditional surgery – Hemorrhoidectomy

The principle of the surgery is to decrease the blood flow to anorectal ring, which is followed by the removal of redundant hemorrhoidal tissue.
 

Indications

• Grade II, III and IV hemorrhoids
• Failure of non-operative treatment of 2nd degree pile
• Thrombosed hemorrhoid
• Interoexternal pile when the external pile is well defined

 
Types

• Excision of hemorrhoids with (closed hemorrhoidectomy) or without (open hemorrhoidectomy) suturing
• Excision by using different energies
• Diathermy
• Harmonic scalpel
• Bipolar scissors

Stapled hemorrhoidopexy / Procedure for prolapsed and hemorrhoids (PPH)
Based on the concept of interruption of the superior and middle hemorrhoidal vessels, and the upward lifting of the prolapsed anorectal mucosa, followed by repositioning of the vascular cushions back into the anal canal, causing atrophy of hemorrhoidal tissue

• For Grade 3 and 4 hemorrhoids
• No incisions are made in the somatically innervated, highly sensitive anoderm, which cause significantly less postoperative pain
• Side effects include rectal perforation, sphincter dysfunction and sepsis
• Advantages:
  1. Simple and quick procedure
  2. Less postoperative pain, shorter hospital stay and earlier return to normal activity
  3. Similar complication rate as conventional procedure

	Staple hemorrhoidopexy	Traditional hemorrhoidectomy
Operative time	Quick, around 30 minutes	40-60 minutes
Postoperative pain	Much less	Painful wound, subsided days to weeks later
Recovery time	Fast, can resume normal activity on next day, avoid strenuous exercise	Slow, requires days to week to resume normal duty
Wound care	Not needed if not infected	Daily wound dressing, for one to two weeks

Hemorrhoidal artery ligation (HAL) and Transanal hemorrhoid dearterialization (TAH)
Video Demonstration


These are for treatment of bleeding and Grade 2 to 3 prolapsed hemorrhoids. Dearterialization is to apply Doppler-USG for identification and selective ligation of the branches of rectal artery, thereby correcting the arterial hyperinflux, which is the main cause of bleeding and swelling of the haemorrhoidal plexus. Mucopexy or rectoanal repair is the reposition of the cushions in their anatomical site by folding the muco-hemorrhoidal prolapsed
 

Benefits

• Minimally invasive and atraumatic
• Marginal post-operative pain
• No grave complications

Reference: psclinic.com.hk/

The information aims to provide educational purpose only. 

Anyone reading it should consult Surgery Specialist before considering treatment and should not rely on the information above.

Haemorrhoid treatment (1)

• Varies from simple reassurance to surgery
• Treat symptomatic disease only
• Depends on grading

It is divided into four categories:

1. Dietary and lifestyle modification to prevent hemorrhoids formation
2. Medications to relieve symptoms
3. Outpatient hemorrhoid treatment
4. Operation

Treatment is according to severity of hemorrhoids

	Dietary and lifestyle modifications	Medications	Outpatient procedures	Operations
Grade 1	✓	✓	+/-	x
Grade 2	✓	✓	✓	+/-
Grade 3	x	x	✓	✓
Grade 4	x	x	x	✓

 

Dietary and lifestyle modification

The goal is to minimize straining at stool by minimizing constipation. Increase fluid intake which acts as stool softeners is encouraged in diet. Moreover, regular defecatory habits should be developed.
 


 Medications

There are two kinds of medications, local and oral medications. This helps to:

• arrest bleeding
• relieve pain, irritation, and inflammation
• guard against infection

 

Outpatient hemorrhoid treatment

• Rubber band ligation, endoscopic ligation
• Sclerotherapy
• Infrared coagulation
• Bicap electrocoagulation
• Cryotherapy
• Laser treatment

 

Banding / Ligation of hemorrhoids

It is carried out for Grade 2 and 3 internal hemorrhoids. The principle of it is to cause ischemic necrosis by banding, which will slough off within a few days. 60-70% successful response rate is found when cured with a single treatment session

Video Demonstration

 

Reference: psclinic.com.hk/

The information aims to provide educational purpose only. 

Anyone reading it should consult Surgery Specialist before considering treatment and should not rely on the information above.

 

OGD---The lumen of the upper digestive tract-

Oesophagogastroduodenoscopy (OGD)

 

 

 

 

OGD is the method for examination of the lumen of the upper digestive tract. OGD means the use of a flexible endoscope to examine the oesophagus (Oesopha-), stomach (Gastro-) and duodenum (Duodeno-).

OGD is indicated for diagnosis, biopsy and delivery of targeted therapies. It may be used for patients suffering from peptic ulcer disease or bleeding, suspected oesophageal and gastric cancer, symptoms of indigestion, acid reflux and difficulty in swallowing.



Procedures

 
1. Prior to the examination, local anesthetics will be sprayed to the throat of patients. Dur the procedure, patients are fully conscious.

2. A flexible endoscope with a diameter of 0.9-1.2cm will then be introduced by the endoscopist through patients’ mouth into the esophagus, stomach and the duodenum.

3. Blood pressure and heart rate will be closely monitored during the procedure.

4. The entire procedure will last for about 10 to 20 minutes.





Reference: psclinic.com.hk/ 

The information aims to provide educational purpose only. Anyone reading it should consult
Surgery Specialist before considering treatment and should not rely on the information
above.


 

Hemorrhoid

Introduction
Hemorrhoid is a very common disease, which affects more than 80% of adults. In the past, hemorrhoid was considered as varicose vein. Recently, it is defined as a vascular cushion resulted from downward displacement of anal cushion, which are blood-filled spaces supported by a matrix of fibrous tissue and smooth muscle located in lower rectum. It is resulted from chronic straining, leading to local congestion due to various reasons such as chronic constipation, diarrhea, prolonged attempts when defecation, prolonged sitting and standing, lack of fibers in diet, etc. Local congestion will cause anal cushions to lose their attachment to the underlying rectal wall, leading to prolapse of internal hemorrhoidal tissue through the anal canal. As these hemorrhoids engorge, vasculature increases and the overlying mucosa become more friable. As a result, rectal bleeding occurs.
Hemorrhoid is classified as internal, external or internoexternal in relation to dentate line at lower rectum. Internal hemorrhoids are located above the dentate line, external hemorrhoids are located below the dentate line, while interno-external hemorrhoids are extended from above to below the dentate line

Clinical features
Hemorrhoids in many patients are found to be asymptomatic, and therefore no treatment is needed.
For symptomatic hemorrhoids, symptoms include:

1. Rectal bleeding – fresh bleeding is found after defecation that stain toilet paper and is separated from stool. Anemia will be results if prolonged bleeding occurs.
2. Prolapse – According to severity, prolapse is divided into different grading:
   
   
   • Grade 1 – bleeding without prolapse
   • Grade 2 – prolapse with spontaneous reduction
   • Grade 3 – prolapse with manual reduction
   • Grade 4 – incarcerated, irreducible prolapse


3. Perianal irritation (itchiness) and discharge (mucus)
4. Pain due to thrombosis of external hemorrhoid

Hemorrhoids in pregnancy
Hemorrhoids can also be found usually in the third trimester during pregnancy. It can be due to hormonal changes, obstruction of venous return by the gravid uterus and chronic straining secondary to constipation. Majority of symptoms can be resolved after delivery. These can be treated with conservative measures and intervention is rarely being indicated.


 


Reference: psclinic.com.hk/
The information aims to provide educational purpose only. Anyone reading it should consult
Surgery Specialist before considering treatment and should not rely on the information
above.

Procedure for prolapsed and hemorrhoids (PPH)

Stapled hemorrhoidopexy / Procedure for prolapsed and hemorrhoids (PPH) 


 Based on the concept that interruption of the superior and middle hemorrhoidal vessels, and the upward lifting of the prolapsed anorectal mucosa and repositioning of the vascular cushions back into the anal canal cause the hemorrhoidal tissue to atrophy
 For Grade 3 and 4 hemorrhoids
 No incisions are made in the somatically innervated, highly sensitive anoderm  


significantly less postoperative pain
 Side effect: Rectal perforation, sphincter dysfunction and sepsis
 Advantages
1) Simple and quick procedure
2) Less postoperative pain, shorter hospital stay and earlier return to normal activity
3) Similar complication rate as conventional procedure

	Staple hemorrhoidopexy	Traditional hemorrhoidectomy
Operative time	Quick, around 30 minutes	40-60 minutes
Postoperative pain	Much less	Painful wound, subsided days to weeks later
Recovery time	Fast, can resume normal activity on next day, avoid strenuous exercise	Slow, requires days to week to resume normal duty
Wound care	No need if not infected	Daily wound dressing, for one to two weeks

Reference: psclinic.com.hk

The information aims to provide educational purpose only. Anyone reading it should consult

Surgery Specialist before considering treatment and should not rely on the information

above.

What is stomach cancer?

Stomach is part of the digestive system. It secretes gastric acid to help breaking down large pieces of food into smaller ones. The food then enters the intestine for further digestion.

Mutations will turn stomach cells into malignant tumor - stomach cancer. It is a general term referring to gastric gland cell cancer, (tumor of smooth muscle), gastric malignant lymphoma, gastrointestinal stromal tumor, of which gastric gland cell cancer represents more than 90% of stomach cancer.
 
What are the risk factors of stomach cancer?

There are many factors leading to stomach cancer. Researches have shown that Helicobacter pylori (a bacteria in stomach) infection may increase the chance of stomach cancer. If you fall into one of these categories, please pay extra attention:

• Gender: men have twice the probability of having stomach cancer than women
• Age: the older the age, the greater the chance of cancer. Patients over 50 have greater chances of having stomach cancer.
• Diet: long term intake of highly salted, processed, pickled or smoked food are more susceptible to stomach cancer.
• Disease: patients with stomach polyps, history of gastrectomy or severe anaemia have higher chances of having stomach cancer
• Smoking: smoker are more likely to have stomach cancer than non-smokers.
• Inheritance: patients with family history of stomach cancer are twice as likely to develop have stomach cancer than others.

Reference: psclinic.com.hk/
The information aims to provide educational purpose only. Anyone reading it should consult
Surgery Specialist before considering treatment and should not rely on the information
above.
 

Gastric cancer

Stomach cancer is the No.4 killer cancer in Hong Kong, with about 1000 new cases annually. The occurrence stomach cancer increases with age. The average age of patients is 65, but it is affecting a younger generation in recent years.

There are no obvious symptoms in early stages of stomach cancer, so it is easily ignored by most patients and only discovered when the cancer is in late stage, when it has been spread to other tissues.

Best prevention of stomach cancer starts from diet control with frequent intake of fresh vegetables and reduced consumption of processed food. If you have recurrent indigestion or poor appetite, please consult your doctor.

Reference: psclinic.com.hk/
The information aims to provide educational purpose only. Anyone reading it should consult
Surgery Specialist before considering treatment and should not rely on the information
above.

Colonoscopy (2)

Procedure:

• Lay on the left side, knees bending towards the abdomen
• Doctors would monitor patient’s vital signs throughout the procedure to ensure safety
• Anesthesia will be given before the procedure
• The endoscope enters through the anus, and travel through the colon, to examine sigmoid colon, descending colon, transverse colon, ascending colon and appendix. Air will be inflated into the colon for better vision of the inner wall.
• Any polyps, ulcer, tumors or any abnormality is observed, it will be surgically removed for further laboratory testing
• The procedure lasts for about 30-60 minutes.

Precautions after procedure

• Once recovered, normal diet can be resumed in most cases.
• Since air is inflated into the intestine, the abdomen will be slightly swollen and flatulence is frequent, but it will eventually diminish.
• Ask for family or friends for company.
• Avoid alcohol, driving or signing important documents within 24 hours.
• If there is any severe abdominal pain or excessive bleeding observed in the anus, please contact medical professionals.

Is colonoscopy safe?

With over 20 years of history, the safety of colonoscopy is well proven. Also, doctor will assess the risk of the procedure to minimize the risk of complications.

• The risk of intestinal perforation due to polyp removal is less than 1 in 2000.
• Mild bleeding will be observed in the site of incision, which will clot by itself, the chance is about 2%.

Reference: psclinic.com.hk
The information aims to provide educational purpose only. Anyone reading it should consult Surgery Specialist before considering treatment and should not rely on the information above.

Colonoscopy (1)

Our colon has a great workload every day – digesting, absorbing and eliminating the food we eat. To maintain a healthy gut, a balanced diet and regular colonoscopy work hand in hand.

Do I need a colonoscopy?

Colon cancer is the second cancer killer in Hong Kong. If you are over 50, or with any problems as stated below, please seek advice from your doctor if you need a colonoscopy.

1. Changes in fecal habits (constant diarrhea / constipation)
2. Feaces with blood or mucus
3. Lumps in the abdomen
4. Continuous abdominal pain
5. Anemia without a known cause
6. Chronic enteritis
7. Family history of colon cancer

What is colonoscopy?

Colonoscopy is a kind of endoscopy which aims at examining the inner wall of the colon. Colonoscopy is made of a very fine optic fiber with a camera at the tip, which sends images of the intestine to a television screen, so doctors can understand the conditions of the patient’s intestine.
Points to note before the examination

• Clear the bowel to remove any fecal substances before the examination. Doctors would prescribe laxatives.
• 3 days before

- Low fiber diet (eg. Rice, noodles, biscuits, winter melon, tofu, fish)
- Avoid high fiber food (eg. Brown rice, oatmeal, fruits, vegetables, fatty meat, roasted meat)

• 1 day before:

- Fluid diet only (eg. Tea, clear soup, rice water, glucose or electrolyte drinks)
- Avoid milk, vegetable juice, grapefruit juice

• 6 hours before:

- Sip of water only (no food allowed)
- Before the examination, you will be given a surgical gown, and taking off all the accessories, including any metal substances, contact lens and dentures.


Reference: psclinic.com.hk
The information aims to provide educational purpose only. Anyone reading it should consult Surgery Specialist before considering treatment and should not rely on the information above.