Proctological diseases (from the Greek procto=anus) are those that involve the right anus. The anus together with the rectum (the last part of the intestine) should be considered as an anatomical-functional unit, dedicated to highly specialized functions, such as:
Specialization
The continuous research in the medical field has changed the old concept of specialization, especially thanks to technological innovation in both diagnostic and therapeutic fields, resulting in outdated specializations in gastro-enterology or colon proctology when it comes to proctological diseases, which today increasingly require the help of super specialists.
Innovation
In proctology in the last decade there has been a real revolution, especially in the therapeutic field, with the increasing use of minimally invasive surgical treatments such as for example:
- THD for the treatment of hemorrhoids,
- VAAFT for the treatment of anal and rectal fistulas,
- EPSIT for the treatment of sacrococcygeal fistulas and sacral neuro-modulation for faecal incontinence.
Professionalism
The Villa Margherita Treatment Center has always been one of the Roman realities, and not only, at the forefront of medical innovation, this mentality has allowed the establishment of a proctology center, led by the team of Prof. Valter Ripetti, for decades engaged in this field, which uses the most modern diagnostic and therapeutic methods.
Hemorrhoids
In most cases, hemorrhoidal disease can be treated on an outpatient basis, using minimally invasive endoscopic treatments.
The most modern and least invasive is THD® Transanal Hemorrhoidal Dearterialization).
THD® the method is performed by the proctologist surgeon with a special device that can accurately and safely identify the terminal branches of the arteries that carry blood to the hemorrhoids.
Once identified, a special suture is performed that reduces the inflow of arterial blood to the hemorrhoids and the prolapse by repositioning the hemorrhoids in their natural location.
The THD® technique is a minimally invasive procedure, as it does not involve any removal of tissue and is absolutely safe.
The procedure is performed in a free site of nerve endings, which reduces the main problem of traditional surgical techniques: the PAIN.
In principle, this procedure can also be performed in an outpatient clinic under local anesthesia with sedation, but it always depends on the patient’s condition and disease.
Perianal fistulas
The therapy is exclusively surgical and among these the VAAFT (Video Assisted Anal Fistula Treatment) is certainly the least invasive. This technique is characterized by a first moment, in which a complete mapping of the fistuous pathology is carried out by means of an optical fiber, and by a second moment in which the diathermocoagulation of the fistula under vision is carried out, eliminating traumas to the sphincter apparatus, and therefore the frightening risk of fecal incontinence, a complication not uncommon when performing traditional techniques. A further advantage of this method, confirming its mini-invasiveness, is determined by the complete absence of post-operative dressings, treatments often necessary with traditional techniques and very painful.
Pilonid disease
The therapy for pilonid disease is also surgical and one of the most modern and less invasive techniques is EPSIT (Endoscopic Pilonidal Sinus Treatment), a technique that is also extremely valid for recurrences after traditional surgery.
The technique is borrowed from VAAFT and therefore also in this case we proceed to the endoscopic mapping of the disease and its subsequent video-guided diathermocoagulation. Even with the help of this technique, post-operative dressings are not necessary, with immediate resumption of normal daily and work activities; but the advantage, which is not negligible, especially in women, is the absence of scars, often disfiguring, the normal outcome of traditional techniques.
Fecal incontinence
The therapy can be pharmacological, rehabilitative or surgical, the choice depends substantially on the type of incontinence and the cause that determined it.
One of the most effective and minimally invasive methods is sacral neuromodulation.
The technique consists in the introduction of an electrode at the level of the sacral foramis S3 or S4 connected to a pace-maker, which remodels the evacuation mechanisms optimizing the anal sensitivity and sphincter tone. The operation does not require any special pre-operative preparation and is performed under local anesthesia without any post-operative pain.
I nostri medici
- Chirurgia generale
- Prof. Valter Ripetti
- Proctologia
- Dott.ssa Daniela Amato
THD® è un metodo per il trattamento delle emorroidi eseguito dal chirurgo proctologo con un dispositivo speciale, che può identificare accuratamente e in modo sicuro i rami terminali delle arterie che portano il sangue alle emorroidi. Una volta individuati si esegue una particolare sutura che riduce l’afflusso di sangue arterioso alle emorroidi e il prolasso, riposizionando le emorroidi nella loro sede naturale.
La tecnica THD® è una procedura minimamente invasiva, in quanto non comporta alcuna asportazione di tessuto ed è assolutamente sicura.
La procedura viene eseguita in una sede libera di terminazioni nervose, che riduce il problema principale delle tecniche chirurgiche tradizionali: il DOLORE.
la VAAFT (Video Assisted Anal Fistula Treatment) è sicuramente la tecnica meno invasiva per le fistole anali e rettali. Questa tecnica è caratterizzata da un primo momento, in cui mediante una fibra ottica viene eseguita una completa mappatura della patologia fistolosa, e da un secondo momento in cui si procede alla diatermocoagulazione della fistola sotto visione, eliminando traumi all’apparato sfinteriale, e pertanto il temibile rischio d’incontinenza fecale, complicanza non rara quando si eseguono tecniche tradizionali. Un ulteriore vantaggio di questa metodica, a conferma della sua mininvasività, è determinato dalla completa assenza di medicazioni post-operatorie, trattamenti spesso necessari con le tecniche tradizionali e molto dolorosi.
l’EPSIT (Endoscopic Pilonidal Sinus Treatment) è una tecnica chirurgica per il sinus pilonidalis estremamente valida anche nelle recidive dopo chirurgia tradizionale.
La tecnica è mutuata dalla VAAFT, pertanto anche in questo caso si procede alla mappatura endoscopica della malattia e alla sua successiva diatermocoagulazione videoguidata. Anche con l’ausilio di questa tecnica non sono necessarie medicazioni post-operatorie, con immediata ripresa delle normali attività quotidiane e lavorative; ma Il vantaggio, per nulla trascurabile soprattutto nelle donne, è dato dall’assenza di cicatrici, spesso deturpanti, normale esito delle tecniche tradizionali.
la NEUROMODULAZIONE SACRALE nel trattamento chirurgico dell’incontinenza fecale, consiste nell’introduzione di un elettrodo a livello dei forami sacrali S3 o S4 collegato ad un pace-maker, il quale rimodula i meccanismi evacuativi ottimizzando la sensibilità anale ed il tono sfinteriale. L’intervento non necessita di alcuna particolare preparazione pre-operatoria si esegue in anestesia locale senza alcun dolore post-operatorio.
La terapia può essere farmacologica, riabilitativa o chirurgica, la scelta dipende sostanzialmente dal tipo di incontinenza e dalla causa che l’ha determinata.
