Dr. Vivek Bindal is the Best Laser Piles Surgeon in North India – WHAT IS A LASER ? Laser is a high-energy light that is used to safely cut or burn the affected tissue during surgical procedures. WHAT IS LASER PROCTOLOGY? Laser proctology refers to the treatment of diseases of the colon, anus, and rectum via laser application.

How is Laser Surgery better than Conventional Surgery?

Laser surgery or laser therapy is a day-care procedure that offers several advantages over traditional surgery. Compared to banding surgery, laser effectively treats hemorrhoids, improves symptoms, and reduces post-operative pain. Similar benefits are seen for patients with severe anal spasms, external thrombosis, fissure, and sentinel tags, fistula & varicose veins due to ever-growing advantages, namely:

• - Less operation time, discharge within a few hours
• - Back to routine life in 3-5 days
• - Greater surgical precision
• - Sutureless treatment with no scars 
• - Fastest recovery as there are no cuts or stitches
• - Quick relief from the symptoms
• - Less blood loss during surgery
• - No or minimal post-operative pain
• - Reduced risk of infection
• - Reduced risk of rectal stenosis or prolapse
• - Aesthetically the best procedures – helps as a confidence booster for the patient.
• - The anal sphincter action is well preserved, (no chances of incontinence fecal leak).
• - Least recurrence rates
• - Fewer doctor visits post-surgery
• - High success rates
• - No need for general anesthesia. Local or spinal anesthesia is applicable for this surgery

WHAT TYPE OF LASER IS USED IN PROCTOLOGY ?

1. What is Laser hemorrhoidectomy?

Laser hemorrhoidectomy is a technique in which the surgeon burns to shrink the swollen hemorrhoids. Alternatively, the surgeon may use a narrow beam of the laser to focus only on the hemorrhoid and not damage the nearby tissues. It is a safe procedure with minimal bleeding and a quick healing time.
A laser fiber is passed through the anal opening and laser energy is applied to the haemorrhoidal mass. The controlled emission of laser energy reaches the submucosa zone, causing the haemorrhoidal mass to shrink. Fibrosis reconstruction generates new connective tissue, ensuring the mucosa adheres to the underlying tissue preventing the recurrence of prolapse

2. How the laser surgery for fissure is done ?

Fistula laser closure (FiLaC) is a novel sphincter-saving procedure for the treatment of anal fistula. Primary closure of the track is achieved using laser energy emitted by a radial fiber connected to a diode laser. The energy causes shrinkage of the tissue around the radial fiber with the aim of closure of the track

3. How the laser surgery for fissure is done?

For anal fissure that is resistant to medical and conservative approaches, a surgery called as lateral internal sphincterotomy (LIS) is performed. During the surgery, a small portion of the sphincter muscle is removed. This helps to reduce pain and pressure and allows the healing of the fissure.

4. Is there any limitation in physical activities post laser surgery?

There is no restriction of physical activities post laser surgery, you are allowed to walk as soon u recover from anesthesia, the patient is allowed to go to the toilet on their own. There is no restriction on climbing stairs, you may even drive two-wheelers or cars as soon as you feel fit.

5. How early can I return back to normal activity / join back work?

The patient can return to normal activities / join back work within 1-2 days after the laser surgery.

6. What are the diet modifications post laser surgery?

The patient is encouraged to adopt a healthy lifestyle with a healthy fiber-rich diet

7. What are the disadvantages of laser surgery?

Laser surgery is safe with lots of benefits, as such there is no disadvantage of laser surgery

8. What are the chances of recurrence after laser surgery?

As per literature, there is a 5-7 % chance of recurrence of perianal disease after laser surgery

SUCCESSFUL VIDEO ASSISTED ANAL FISTULA TREATMENT (VAAFT) IN 36 YEAR OLD MALE WITH COMPLEX PERIANAL FISTULA

36 year old male patient presented with acute pain and puss discharge peri-anal region. He was examined, investigated and found to have complex perianal fistula. In these challenging complex fistulas with sphincter involvement and high fistulas; VAAFT is procedure of choice as in these complex fistulas require sphincter saving surgery to avoid cutting of sphincter and faecal incontinence. VAAFT is minimally invasive and sphincter-saving technique for complex high fistulas. The technique is based on direct endoluminal vision; giving the advantage to identify missed fistulas tract and high internal opening. Internal opening is closed through anal route and whole of the tract is destroyed under direct vision using electrode. Procedure is of advantage of having very small post-operative wound, next day discharge and least post-operative pain. In this patient under spinal anaesthesia fistuloscopy was done. Multiple fistulas tracts were identified along with internal opening. Internal opening is closed and tracts were cauterized using electrode. Postoperative next day patient was discharged with very less pain and no major dressing. Why vaaft is better than standard fistulectomy in complex high peri-anal fistula??? Perianal fistulas can present with single or multiple tracts. Tracts can be intersphinteric, transsphinteric, suprasphinteric or extra sphinteric. VAAFT is procedure of choice in high complex anal fistulas giving the advantage to identify missed fistulas tract and high internal opening. Internal opening is properly identified and whole of tract is cauterized; preserving the sphincter. Whereas performing standard fistulectomy in complex high transsphinteric fistulas includes cutting of sphincter and resulting in large wound with fecal incontinence, increasing the morbidity of patient.

Constipation : Everything Thing you Need to Know

Definition of constipation ?

Less than three bowel movements a week is, technically, the definition of constipation. However, how often you “go” varies widely from person to person. Some people have bowel movements several times a day while others have them only one to two times a week. Whatever your bowel movement pattern is, it’s unique and normal for you – as long as you don’t stray too far from your pattern.
Other key features that usually define constipation include:

• - Your stools are dry and hard.
• - Your bowel movement is painful and stools are difficult to pass.
• - You have a feeling that you have not fully emptied your bowels.

What is the prevalence of constipation ?

The findings suggest that 22% of the adult Indian population is suffering from the condition, with 13% complaining of severe constipation. 6% of the Indian population suffer from constipation associated with certain comorbidities.

Who is more likely to become constipated?

Certain people are more likely to become constipated, including2

• - women, especially during pregnancy or after giving birth
• - older adults
• - non-Caucasians
• - people who eat little to no fiber
• - people who take certain medicines or dietary supplements NIH external link
• - people with certain health problems, including functional gastrointestinal disorders

Complications of constipation ?

Complications of chronic constipation include:

• - Swollen veins in your anus (hemorrhoids). Straining to have a bowel movement may cause swelling in the veins in and around your anus.
• - Torn skin in your anus (anal fissure). A large or hard stool can cause tiny tears in the anus.
• - Stool that can’t be expelled (fecal impaction). Chronic constipation may cause an accumulation of hardened stool that gets stuck in your intestines.
• - Intestine that protrudes from the anus (rectal prolapse). Straining to have a bowel movement can cause a small amount of the rectum to stretch and protrude from the anus.

Prevention

The following can help you avoid developing chronic constipation.

• - Include plenty of high-fiber foods in your diet, including beans, vegetables, fruits, whole grain cereals and bran.
• - Eat fewer foods with low amounts of fiber such as processed foods, and dairy and meat products.
• - Drink plenty of fluids.
• - Stay as active as possible and try to get regular exercise.
• - Try to manage stress.
• - Don’t ignore the urge to pass stool.
• - Try to create a regular schedule for bowel movements, especially after a meal.
• - Make sure children who begin to eat solid foods get plenty of fiber in their diets.

Treatment

Laxatives

Several types of laxatives exist. Each works somewhat differently to make it easier to have a bowel movement. The following are available over the counter:

• - Fiber supplements. Fiber supplements add bulk to your stool. Bulky stools are softer and easier to pass. Fiber supplements include psyllium , calcium polycarbophil and methylcellulose.
• - Stimulants. Stimulants including bisacodyl (Correctol, Dulcolax, others) cause your intestines to contract.
• - Osmotics. Osmotic laxatives help stool move through the colon by increasing secretion of fluid from the intestines and helping to stimulate bowel movements. Examples include oral magnesium hydroxide ( Milk of Magnesia, others), magnesium citrate, lactulose , polyethylene glycol.
• - Lubricants. Lubricants such as mineral oil enable stool to move through your colon more easily.
• - Enemas and suppositories. Tap water enemas with or without soapsuds can be useful to soften stool and produce a bowel
movement. Glycerin or bisacodyl suppositories also aid in moving stool out of the body by providing lubrication and stimulation.

Other medications

If over-the-counter medications don’t help your chronic constipation, your doctor may recommend a prescription medication, especially if you have irritable bowel syndrome.

• - Medications that draw water into your intestines. A number of prescription medications are available to treat chronic constipation.Lubiprostone, linaclotide and plecanatide work by drawing water into your intestines and speeding up the movement of stool.
• - Serotonin 5-hydroxytryptamine 4 receptors. Prucalopride helps move stool through the colon.
• - Peripherally acting mu-opioid receptor antagonists (PAMORAs). If constipation is caused by opioid pain medications, PAMORAs such as naloxegol and methylnaltrexone reverse the effect of opioids on the intestine to keep the bowel moving.

Training your pelvic muscles

Biofeedback training involves working with a therapist who uses devices to help you learn to relax and tighten the muscles in your pelvis. Relaxing your pelvic floor muscles at the right time during defecation can help you pass stool more easily.
During a biofeedback session, a special tube (catheter) to measure muscle tension is inserted into your rectum. The therapist guides you through exercises to alternately relax and tighten your pelvic muscles. A machine will gauge your muscle tension and use sounds or lights to help you understand when you’ve relaxed your muscles.

Surgery

Surgery may be an option if you have tried other treatments and your chronic constipation is caused by a blockage, rectocele or stricture. For people who have tried other treatments without success and who have abnormally slow movement of stool through the colon, surgical removal of part of the colon may be an option. Surgery to remove the entire colon is rarely necessary.