In proctology, mini-invasive surgery has recorded real advances in recent years, according to a session of the National Academy of Surgery. There Dre Béatrice Vinson-Bonnet (Digestive, proctological and visceral surgery, Chi Poissy/St-Germain-en-Laye) opened the debate by saying that ” All techniques, all surgical approaches today, thanks to technology, go to mini-invasive techniques “, more ” Before making the decision to operate, medical treatment is prescribed in the event of hemorrhoids. This treatment mainly aims to correct intestinal transit disorders, including constipation, as well as to educate people on good practices to go to the saddle ». If the treatment fails, then we are considering surgery. “” Until the 2000s, hemorroidectomy was the only option. Since then, less painful methods have been developed for this benign pathology in order to reduce postoperative pain, including the Podendal block. It is an anesthesia of the nerves of the anus, called a pudendal nerve, with a long -term product. The patient wakes up without pain for 12 to 24 hours, which is beneficial for the post-operative period after hemorrhoidal surgery. However, in the event of hemorroidectomy, the passage of the stools on the wounds can be very painful of the 3e au 10e day. Healing can take about a month and a half Adds the Vinson-Bonnet DRE.
Circular stapling
Proctologists therefore looked for mini-invasive techniques, ” To do surgery without wounds. In the 2000s, the surgeon Antonio Longo introduced the circular stapling to superficially cut the bottom of the rectum and lift hemorrhoids in the anus. Although revolutionary, this method led to serious complications. It has often been replaced by a simpler technique, using an anuscope to locate and ligate the small arteries in the anus “Explains Béatrice Vinson-Bonnet. Disadvantages of these techniques: they can only be used on internal hemorrhoids and do not allow to remove the large external hemorrhoids, often caused by thrombosis, especially after childbirth in women. Another drawback: the symptoms reappear in 20 % of cases within 2 years, continues the DRE Vinson-Bonnet.
Thermofusion
Thermofusion is another technique that appeared recently: “ Thermofusion uses microwaves to completely dry up internal hemorrhages. This recent method is being evaluated, but already known. You can also use radiofrequency or, more rarely, laser “, Details the Vinson-Bonnet DRE.
Anal incontinence
The Pre Émilie Duchalais (Visceral and digestive surgeon, Institute of Diseases of the Digestive system, Nantes University Hospital) presented mini invasive developments in the management of anal incontinence. These are two techniques, ” Sacred neuromodulation and Botox, but which are mainly reserved for patients who have fecal incontinence “Explains Pre Émilie Duchalais. Who specifies that these techniques only intervene ” second or third line of treatment “, After a failure of medical treatment or rehabilitation.
Sacred neuromodulation
Sacred neuromodulation consists in stimulating nerve roots near the sacrum, involved in the functions of sphincters and the sensitivity of the rectum. Five to 10 years after neurostimulation, lasting results are observed in 50 to 70 % of patients. The advantage of neurostimulation lies in the fact that a test can be carried out. This implies the implementation of electrodes at the place provided for stimulation, making it possible to test the effectiveness of the treatment for 2 to 3 weeks. “” If, during this period, the patient notes a reduction of at least 50 % of episodes of incontinence, the device will be implemented permanently. This device, similar to a pacemaker, but located at the buttocks, will remain in place for at least 5 years, depending on the life of the batteries »Details the Pre Duchalais.
Botox
« Botox is used by urologists to treat hyperactive bladder. The toxin prevents muscles from contracting by blocking the action of acetylcholine, thus reducing urinary leaks. Similarly, in the rectum, Botox blocks muscle contractions and neural connections operating with acetylcholine, thus improving muscle control “Adds the Pre Duchalais. “” Botox has revolutionized the treatment of incontinence, but its effects last only 6 to 9 months. In a recent study, the results nevertheless show that after 5 years, patients need an injection every 3 years on average She adds.
Fat injection
Another technique, based on fat, is currently being evaluated, adds the Dre Duchalais: ” Current studies relate to the injection of fat in the sphincter to treat incontinence by imperiality. This aims to restore tone to the sphincter, using the capacity of the stem cells of fat to reproduce muscle. A study by Rennes University Hospital explores this technique, with promising preliminary results. This method is still experimental, but shows positive signs in patients. »
