What are the Symptoms of Perianal (Rectal Circumference) Fistula?

When abscess occurs, severe pain and discharge occurs in this area. However, sometimes without creating such a noisy picture, it shows itself like a pimple around the anus. When it is plastered, stool or a bloody inflamed fluid may come from this canal opening. These fistulas cannot heal spontaneously, they must be treated surgically. In particular, it is necessary to investigate the reasons for its occurrence. Usually they tend to recur when seen with intestinal diseases such as Crohn’s disease.

How is the Diagnosis Made in Perianal (Rectal Circumference) Fistulas?

In perianal fistulas, there are a number of diagnostic steps that must be done after the outer mouth is detected. Finding the inner mouth of these fistulas and the route they follow in the anus wall is very important and determines the treatment method to be applied. First of all, it is tried to determine the location of the inner mouth with a device that shows an area of 10 cm inside the anus, which we call a finger examination and anoscope, because 20% of these fistulas are simple fistulas and can be easily treated. Fistulography, which used to be a method used to shoot films by giving drugs from the outer mouth of the canal, is now being gradually abandoned due to the fact that the fistula does not determine the path followed by it and the margin of error is high. The safest method for today is to determine the path of the fistula and the location of the inner mouth by MRI and to plan the treatment accordingly.

How is the Treatment Done in Perianal (Rectal Circumference) Fistulas?

If the perianal fistula is detected as a simple fistula in the MRI examination, it is easy to treat and the fistula canal is opened by surgery. In up to 60% of patients, the fistula passes through or between the muscles that allow us to hold our stool, in which case an additional process called seton should be added to the disruption of the fistula canal. In 20% of the patients, the inner mouth of the fistula has extended up to the large intestine. In this patient group, treatment is much more difficult and larger surgical procedures may be required.

Recently, laser treatment models have been used in perianal fistula patients. These treatment models are based on the principle of burning the inside of the canal with laser after the patient has had the infection in the fistula. Although it is much more comfortable for the patient compared to surgical treatment, its use is limited. Since the burned fistula passes through the intra-anus muscles, serious strictures in the anal exit and revision operations may be required after recovery.

How is Postoperative Recovery in Perianal (Rectal Circumference) Fistulas?

Fistula surgery is one of the most unpleasant topics of general surgery. Postoperative 4-6 weeks of follow-up and recovery period are required. During this period, attention should be paid to the hygiene of the anus area, and attention should be paid to prevent recurrence of the infection with applications such as shower and sit-bath during the day.

Perianal Fistula yazısı ilk önce Assoc. Professor Soykan Barlas üzerinde ortaya çıktı.

• Provides both growth and intelligence development of the baby in the womb,
• Provides contraction of muscles in adults,
• Supports the breakdown of fats and carbohydrates,
• Increases protein synthesis,
• It also contributes to the development of intelligence in adults.

What is a goiter? What are the types of goiter?

Goiter is the name given to the enlargement of the thyroid gland in short. This growth can occur with the emergence and growth of the lumps called nodules, as well as the growth of the entire thyroid gland without nodules. As a result of this growth, the thyroid gland sometimes begins to secrete excessive thyroid hormone. This condition is called hyperthyroidism. Sometimes, the thyroid gland remains normal and grows without any increase in hormones. This condition is called euthyroidism. The condition in which the thyroid gland secretes less hormones than its normal values is called hypothyroidism. It can be detected in many disorders and situations. The most common example is Hashimoto’s thyroiditis, one of the inflammatory diseases of the thyroid gland. Thyroiditis is the general name given to the inflammatory disease of the thyroid gland.

How is goiter diagnosed?

Reasons for consulting a physician; swelling in the neck, palpitations in the case of hyperthyroidism, shortness of breath, getting tired quickly, weight loss, fatigue, exhaustion, hair loss and weight gain in the case of hypothyroidism. When the patient applies to the physician with these complaints, the thyroid hormone values are checked first and an ultrasound is performed for the thyroid gland. If necessary, thyroid scintigraphy helps the diagnosis. In the examinations, it is evaluated whether the thyroid gland is enlarged, whether there is a nodule and whether the gland secretes excessive hormones. In the next stage, if there is a suspicion of cancer in the nodules, a biopsy is taken from the suspicious nodule with an ultrasound-guided needle. If there is no suspicion of cancer, medication is started according to the hormone status and the patient is followed up.

Who should have surgery for goiter?

Not every goiter patient needs surgery. When a goiter is detected in a patient, he usually performs, treatment is initiated and / or the patient is followed up by an endocrinologist. The patient with goiter should undergo surgery in the following cases;

• Cancer or suspicion of cancer in the needle biopsy,
• Enlarged thyroid gland compressing the windpipe,
• Enlarged thyroids extending down from the breastbone,
• Cosmetic reasons,
• Family history of thyroid cancer,
• Generally, surgery is recommended for thyroid nodules larger than 4 cm, as it becomes difficult to detect cancer cells with needle biopsy.

Apart from these cases, patients with goiter recently can be tested for the risk of thyroid cancer by performing a gene test. If there is a high risk in the gene test, it is useful to remove the thyroid tissue with surgery.

How is goiter surgery and treatment?

In patients who are decided to have surgery, the thyroid gland is completely or completely removed, or almost completely. Goiter surgery can be performed generally openly, very rarely laparoscopically in selected patients. In open surgery, the 6-7 cm longitudinal cut-off thyroid gland is removed. The patient stays in the hospital for one night and is discharged the next day after the controls are completed. Since the thyroid gland is removed after surgery, thyroid hormone should be taken orally for life.

What are the complications that may occur during and after goiter surgery?

The thyroid gland is one of the body’s most blood-drenched organs and is also located just above the nerves that stimulate the vocal cords. In addition, parathyroid glands that secrete calcium into the blood are located just near the thyroid gland. Depending on the complications that may occur; 

• Bleeding occurs in the first hours after surgery. It can be prevented with careful surgery, but no matter how careful it is, it can be seen with 1-2% possibility after surgery.
• Infection is very rare. It usually occurs with the development of a reaction to the suture materials used in surgery.
• Damage to the vocal nerves can be unilateral or bilateral. Unilateral vocal nerve damage is 2-3%, and bilateral nerve damage is much less common. There may be permanent or temporary hoarseness after surgery. If the nerve damage is bilateral, shortness of breath may develop.
• Calcium deficiency is caused by accidental removal of the parathyroid gland or its malnutrition during surgery. It can be temporary or permanent. It is treated by oral calcium and vitamin D.
• Permanent thyroid hormone deficiency (hypothyroidism) occurs after the thyroid gland is removed due to its inability to secrete hormones. The patient must use oral thyroid hormone for life.

Can’t the complications that may occur during surgery be prevented?

It is possible to reduce the risk of complications that may occur during surgery with the help of special tools to be used in surgery. The risk of bleeding can be eliminated by using devices that connect the vessels by burning, and the risk of hoarseness by using devices that show the location of the vocal nerve. However, the use of these devices unfortunately increases the cost of surgery a little.

Thyroid gland diseases and Goiter yazısı ilk önce Assoc. Professor Soykan Barlas üzerinde ortaya çıktı.

How to diagnose inguinal, umbilical or incisional hernia?

The diagnosis of anterior abdominal wall hernias is usually easily made by a general surgery physician even when it is only examined manually. In cases where there is suspicion, the patient is obese or may be confused with other diseases, the diagnosis is finalized with ultrasonography.

What is an inguinal hernia? What are the symptoms?

It manifests itself with swelling in both groin areas or ovaries. A fatty structure called the omentum or a sac around part of the abdominal organs such as the small intestine comes out. It can be unilateral or bilateral. Classically, it swells when standing, and can be pushed back manually when lying down. In cases where the hernia cannot be taken back into the abdomen, the organs in the hernia sac may be squeezed and strangled. This condition is painful and requires immediate surgical intervention.

How is inguinal hernia surgery performed?

Hernias in the groin area can be treated with open surgery or small incisions (laparoscopically). Both techniques have advantages and disadvantages over eachother. Open surgery can be performed under local anesthesia without the need for general anesthesia. An incision of approximately 6-cm long is generated. The patient can be discharged on the evening of the same day, approximately 6-8 hours after the operation. In cases that make it difficult for the patient to receive anesthesia, such as blood pressure and heart disease, the surgery can be performed smoothly with the support of mild sedative drugs. On the other hand, general anesthesia is required in laparoscopic surgery. This technique is especially advantageous in patients with bilateral inguinal hernia. It prevents the generation of two separate scars since it allows surgery on both groin areas through the same holes. In addition, in laparoscopic surgery, since the patch we call mesh is placed under the abdominal wall, there is less pain in the early postoperative period.

How is recovery after inguinal hernia surgery?

A patch should definitely be placed in inguinal hernia surgery in adult patients. This patch adheres to the tissue of the area where it is placed in a period of 3-4 weeks postoperatively. For this reason, one month after surgery should be careful and heavy work should be avoided. At the end of this period, patient can safely return to daily activities. In heavy-duty individuals and professional athletes, this period should be extended for 2-4 weeks if possible.

What is an umbilical hernia? What are the symptoms?

It is the protrusion of the adipose tissue called the intraabdominal omentum or the internal organs wrapped in a pouch from the area of the navel. It is manifested by the disappearance and even swelling of the navel. It can go back spontaneously when it is pushed in with a finger while lying down. Surgery is recommended in cases where the opening of the hernia is greater than 3 cm. In some cases, intra-abdominal adipose tissue called omentum can be squeezed into the hernia sac.

 How is an umbilical hernia surgery performed?

Umbilical hernia surgery can be performed either by open surgery or laparoscopically. In open surgery, the hernia sac is reached with an incision made around the navel. In this way, the incision scar is hidden. In incisions larger than 3 cm, repair must be made with a patch.In laparoscopic surgery, the operation is performed by entering into the abdomen with three small incisions. Open surgery is preferred in cases where intraabdominal organs such as intestine are stuck in the hernia sac.

Incisional hernia

In patients who have had surgery on the anterior abdominal wall before, it may take a long time for the abdominal wall to return to its former strength or a hernia may have occurred before the abdominal wall heals. When incisional hernia is detected, it usually requires surgery, because incision hernias tend to grow.

How is incision hernia surgery performed?

In incisional hernia surgeries, if it is thought that there may be intra-abdominal adhesions due to the previous surgery, open surgery is preferred. Nevertheless, laparoscopic surgery can be applied in selected hernia cases.

Intra Abdominal Cancer Surgery yazısı ilk önce Assoc. Professor Soykan Barlas üzerinde ortaya çıktı.