June 5, 2025 Author : Jaime Vilaça (general surgery) Proctology is dedicated to the diagnosis and treatment of diseases in the anus and peri-anal area , which are mainly: Hemorrhoids , which are dilated blood vessels that can bleed, cause pain or pruritus (itching); Anal fissure , which is a wound on the edge of the anus associated with very intense pain; Perianal fistula , which is a complication of an abscess and causes intermittent purulent discharge and pain; Sacrococcygeal cyst or pilonidal disease , between the buttocks, causes infection, pain and purulent discharge. These diseases: Affect women and men of all ages; Constipation is an important risk factor for hemorrhoids and anal fissures; Younger ages and greater hairiness favor the occurrence of sacrococcygeal cysts. Perianal fistulas are common after an abscess near the anus has been drained. The medical specialties that most frequently intervene in proctological diseases are general surgery and gastroenterology . The joint work of these specialists makes it possible to determine the most appropriate treatment for each case, since several surgical and non-surgical treatment approaches are currently available. New treatment approaches In recent years, several minimally invasive techniques have been developed for the treatment of anal and perianal diseases . For hemorrhoids The HAL-RAR technique , or hemorrhoidal artery ligation (HAL) and recto-anal repair (RAR), is a non-cutting surgery in which the hemorrhoidal vessels, identified by ultrasound, that feed the hemorrhoids, are ligated above the anal canal. This stops blood from reaching the hemorrhoids, which then dry up. It has been associated with a smooth post-operative period . For anal fissures Injections of botulinum toxin (Botox) into the internal anal sphincter are now available, causing relaxation and facilitating healing of the fissure. With immediate pain relief, this optimized medical treatment can avoid surgery. For perianal fistulas With VAFT treatment - video-assisted anal fistula treatment - an endoscopic view is achieved inside the fistula, and then the ducts are destroyed and the abscesses drained, sparing the anal sphincter. The post-operative recovery is much milder than that of conventional surgery and the risk of anal sphincter injury is lower. For sacrococcygeal cysts With the EPSiT technique or endoscopic pilonidal sinus treatment, an endoscope/fistuloscope is used to enter the cyst and treat it internally, removing the hair and then cauterizing it with a laser to prevent recurrence. After surgery, there is no pain or complicated dressings, and it is not necessary to take breaks from classes or work to achieve an adequate recovery. For premalignant tumors of the rectum The endoscopic TAMIS technique allows a complete and minimally invasive resection through the anus. It is associated with good evolution and less pain during recovery. Postoperative period of minimally invasive interventions The above-referred techniques have in common being much less traumatic for the tissues than traditional surgical treatments. Their greatest advantage for patients is the quality of the postoperative period , with: Much less pain; Faster recovery; Less absence from work or school. The fact that they allow maintain anatomy is also noteworthy, since in some cases this may be associated with a lower risk of complications, including incontinence and anal stenosis (tightening). Meet the general surgery clinical team from Hospital da Luz network. The content published in the Health Guide is intended for the general public and is provided for informational and educational purposes only. It does not replace individual medical assessment, diagnosis, or personalized clinical advice from a qualified healthcare professional. The content is produced or reviewed by physicians and other healthcare professionals at Hospital da Luz and is based on the knowledge available at the time of publication or the most recent update, as indicated at the beginning of each item.
