Proctology


Diagnosis

We take plenty of time to get an accurate patient history in order to understand the real problems from which our patients are suffering. During the subsequent examination, there will be a detailed inspection of the perianal region using a finger (digital rectal examination). The texture and function of the sphincter will be taken into account in particular.

A colonoscopy is carried out to examine the rectum. In order to do this, a small amount of air is blown in, which is then removed again at the end of this examination. Among other things, this colonoscopy serves as a precaution against intestinal cancer.

In the subsequent proctoscopy, the lower half of the rectum is examined, in particular the region in which the stool is released, taking into account haemorrhoidal tissue (haemorrhoids). In this way, changes can easily be recognised and immediately treated. If necessary, tissue samples may also be taken and passed on to the pathologists for examination.

For certain issues, we will request laboratory tests of the blood and the stool. Stool tests are becoming increasingly important in terms of our patients' nutritional status and in order to check the intestinal health.

Conservative treatment

In proctology, conservative treatment can be carried out to an unlimited extent in an outpatient environment and does not require any preparation. This includes the sclerotherapy of both the haemorrhoids and other changes to the lower half of the rectum. If there are extensive results in this section of the intestine, the rubber band ligation known as Barron is used. These two procedures are pain-free. With the rubber band ligation, symptoms can occasionally occur for short periods in some sections of the intestine, but these can be treated with painkillers.

In the region of the skin in and around the anus, ointments, creams and sometimes suppositories with various different active ingredients can be used. It is most sensible for this to take place after the treatment of the intestine, as inside almost exclusively the causes of the external symptoms can be found.

Part of conservative therapy is also individual diet optimisation. Supplementary to this and in support of this, the intestinal flora must be controlled and if necessary stabilised. It is precisely poor diet, environmental toxins, heavy metals, food intolerances and treatment with antibiotics, chemotherapeutic agents, painkillers and cortisone which lead to damage to the "useful" and "important" intestinal bacteria. This means that less useful or pathogenic bacteria (those which make you ill) can multiply to a disproportionate extent. The intestinal flora shifts and important symbioses are lost, resulting in disturbances to digestion and impairment of the immune system.

Where there is decreased sphincter strength for any of a wide range of reasons, pelvic floor exercises and biofeedback therapy are part of conservative treatment.

 

Operative treatment

General

I carry out more than 90% of proctological operations in an outpatient or short-term hospitalisation environment. The operations are all carried out in accordance with regulations and are based around the patient's general risk.

I carry out operations which require local anaesthetic in the practice.

I carry out operations under general anaesthetic in the outpatient operation centre (Ambulantes Operations-Zentrum, AOK) Munich North, where the anaesthetic is administered by experienced anaesthetists. This also includes monitoring in the period after the anaesthetic.

From the moment they are discharged from the AOZ, I am available as a contact and attending physician for my patients around the clock until they are completely healed.

Range of operations

Operations on anal thrombosis, short fissures, anal abscesses, short anal fistulas and the removal of individual skin tags are all carried out under local anaesthetic. The removal of hypertrophic anal papillas and deep rectal polyps are carried out under local anaesthetic. Infections such as condylomata acuminata (genital warts) are treated under local or general anaesthetic depending on the extent of the infection.

Operations which are carried out under general anaesthetic include those for deep anal fissures, which are carefully cut out. Anal fistulas are treated with a variety of different methods depending on the progression. This may be simple splitting, excision, a mucosal flap, fistula pulling or bracketing using OTSC proctology. It is sometimes also necessary to reconstruct the sphincter.

The most important criterion for these operations is that the function of the sphincter muscle may not be impaired after the operative wound has healed.

Further operations which are carried out under general anaesthetic are those for haemorrhoids. I offer the operation methods in accordance with by Milligan-Morgen or Ferguson. I also offer haemorrhoidopexy in accordance with Longo, a method which involves the use of a circular stapler – probably the most commonly used operative method for haemorrhoids nowadays.

Transanal excision and removal of polyps are also carried out under general anaesthetic, as is the reconstruction of the sphincter.