What are the most common anal diseases?
The anal diseases with the highest incidence are basically anal fissure, hemorrhoids and anal fistula. It is true that in this specialty there are many more diagnoses but the three main groups are the patient with anal fissure pain, the patient with blood or prolapse derived from hemorrhoids or the patient with an infectious process, anal fistula type either by an abscess or by a communication between the anus and the outside of the perineum.
In recent years, what advances have been made in the treatment of this type of pathology?
In these three pathologies there have been different attempts to improve this treatment. In anal fissure, for example, nitroglycerin ointments have been tested since about 2005, and at first they seemed to be an important advance in the treatment of anal fissure, but later we saw that we had to operate on these patients just as if they had not taken nitroglycerin. In fact, in 2010 a multicenter study at European level showed that nitroglycerin greatly relieves patients but does not cure them in a decisive way. After one year, the number of patients we had to operate on was very similar to that of patients who had not taken nitroglycerin.
In the field of anal fistulas, there have been advances in the treatment of the most complex fistulas, the less complex fistulas are still treated in the classic way, with fistulotomy, which leaves a wound and then the patient heals little by little. But with complex fistulas, in order to try to section less and less sphincters with this surgery, we have devised different systems, for example glue, which is like a kind of glue that is put through these fistulous tracts, even the laser of the fistulous orifices, the advancement flap to advance a mucosal orifice that will plug the internal orifice of these fistulas. But all these procedures, apart from the classic fistulotomy, do not have an equal success rate. It is true that on many occasions we have no other solution than to use this other type of surgery or procedure to try to tackle this fistula problem without sectioning a large part of the sphincteric mechanism.
In the field of hemorrhoids, progress has been made using Doppler, which is a system to locate the vascular flow of these three groups of veins that we have in the anus, which are the hemorrhoids, and then to perform a ligation or suture of this vascular pedicle. In spite of this, we must continue to say that the classic hemorrhoidectomy is the most effective and definitive treatment for hemorrhoids in their maximum stage, stage 4. It is true that in earlier stages we continue to use bands, which consist of a ligation of the internal hemorrhoids so that they stop maintaining the two important symptoms which are bleeding and prolapse, that is to say that the patient notices that there is something coming out through his anus. And basically these are the advances, there have not been very important advances in these three pathologies.