Anal dilatation is a surgical intervention whereby the anal canal is dilated by fingers or dilator. It is primarily performed to cure obstructions that lead to the constriction of the anal canal such as anal stenosis or post-operative scarring.
Anal Dilatation Indications
The anal dilatation is typically prescribed in the following situations:
Anal stenosis (narrowing of the anal canal through scar tissue, surgery or chronic inflammation).
Post hemorrhoidectomy complications in which scarring results in tightness.
Inborn diseases such as anorectal malformations in children.
It is painful to defecate because of tight anal sphincter or fissure.
Conservative management should be used as a preliminary step before any surgical procedure such as sphincterotomy is done.
Anal Dilatation Procedure:
Patient Preparation
Positioning: Patient is normally positioned in lithotomy (lying on the back with legs elevated) or side-lying position.
Hygiene: The rectum is sponged with antiseptic solution.
Anaesthesia: According to age, tolerance to pain, and severity:
Adults: Local anaesthesia (ointment or injection).
Sedation or general anaesthesia of children or nervous patients.
Consent: The consent is taken by the patient or their guardians after the description of the procedure and risks.
Lubrication
To minimise trauma and pain, a lubricant made of water is used on the fingers or anal dilators.
Dilatation Technique
Finger Dilatation:
A lubricated finger with gloves is carefully thrust into the anal canal.
The anal sphincter is steadily and gradually lengthened.
The stretching process is sustained between 1 and 2 minutes and the finger taken out.
Dilator Dilatation (in case of severe stenosis or children):
Graded anal dilators of all sizes are inserted.
Each size is held concentration on a couple of minutes followed by transferring the size to the next larger size.
The process can be carried out on a daily basis or after every few days, as per the condition.
Post-Procedure Care
Not severe pain or discomfort is normal between 1 and 2 days.
High-fiber diet or stool softener is to be used to prevent trauma.
Warm sitz bath can be effective to relieve pain and relaxation of the muscles.
Prescription is normally to carry on with regular dilatation at home.
Duration
The sessions typically take 5 to 10 minutes.
Different sessions can be needed in days to weeks as per the severity.
Anal Dilatation Treatment:
Anal dilatation may be used as a non-surgical (conservative) form of treatment or as an after surgical management option:
Conservative Treatment
In mild to moderate anal stenosis.
Slowly done by fingers or anal dilators.
Helps loosen anal sphincter and loosen scar tissue.
Fiber-rich diet, sitz bath, and some stool softeners are often used together with them to achieve better results.
Post-Surgical Treatment
Following operations such as hemorrhoidectomy, fissurectomy or congenital anorectal operation.
Prevent reoccurrence of stenosis.
May needs long term or intermittent anal canal dilatation to stay patent.
Anal Dilatation Surgery:
Anal dilatation surgery is an operation to dilate a narrowed anal canal (anal stenosis) which cannot be treated by conservative dilatation only. It is less manual or home dilatation and is more controlled and precise.
Types of Surgical Anal Dilatation:
Manual/ Controlled Surgical Dilatation
Under general or regional anaesthesia.
Surgeon extends the anal canal gradually with the help of special dilators so that they do not damage the sphincter.
Normally performed either once or a few times based on the severity.
Sphincterotomy (if needed)
Tension is relieved by making a small incision at the anal sphincter in certain instances.
Helps enlarge the canal and avoidance of stenosis.
Skin Flap or Reconstruction Surgery
It is applied when there is severe scarring or natural constriction.
The reconstruction of the anal canal and the preservation of anal patency are achieved with the help of a piece of skin of the perianal area.
Factors Affecting Anal dilatation procedure cost in India
The price of anal dilatation is subject to an enormous fluctuation based on several factors:
Type of Procedure
Conservative/manual dilatation: It is less expensive because it is an outpatient procedure and has minimum equipment.
Surgical dilatation (anaesthesia or sphincterotomy): This is more expensive as it involves use of operating room, anaesthesia and aftercare.
Reconstructive surgery or flap surgery: The most costly because of difficulty and prolonged recovery.
Hospital or Clinic
Specialty clinics or private hospitals are more expensive than the public ones.
The pricing is influenced by the reputation and location of the hospital.
The high-surgical and post-operative care facility can be more expensive.
Anaesthesia Type
Local anaesthesia: Cheaper.
Sedation or general anaesthesia: This is more expensive because there is the cost of the anaesthesiologists and the usage of the operating room.
Duration and Complexity
Simple dilatation: Brief process, low prices.
Chronic or severe stenosis: Can take several sessions or a complicated surgery, which creates a higher cost.
Such related interventions as skin flap repair or sphincterotomy increase total cost.
Geographic Location
Prices depend on the city and nation.
Big cities and hospitals with a world-famous status tend to be more expensive.
Hospital Stay
Outpatient procedures are cheaper.
Observation or hospitalization procedures that demand an overnight stay are more expensive.
Drugs and After-Care
Pain medicine, stool softeners and ointments are optional.
Additional expenses may also be included in the form of follow-up visits and instructions on home-care.
Age and Patient Condition
Patients or children with inheritable problems might require specialized care and this adds to the cost.
Comorbid patients can be asked to undergo further monitoring or tests.
Top colorectal surgeons for anal dilatation India
Dr. Paritosh S Gupta
Dr Paritosh S Gupta is a Head of the Department, General, Min Access & Bariatric Surgery at Artemis Hospitals, Sector 51, Gurgaon, India. With an exhaustive list, having of more than 14,000 successful surgeries performed to his credit, he is considered as one of the best and experienced hand in his field. He has vast experience in all kind of abdominal surgeries and Gastro-intestinal surgeries.
Dr. Adarsh Chaudhary
Having trained in UK and the USA, Dr. Adarsh Chaudhary is a doctor with a rich experience in Hepatabillary and Pancreatic surgery. He was instrumental in starting one of the first departments of Surgical Gastroenterology in India. He has also won a number of highly prestigious awards and has been inducted in to respected medical associations such as his fellowships at the Royal College of Surgeons, Edinburgh and the World Health Organization, USA.
Dr. Niranjan Naik
Dr. Niranjan Naik is a renowned senior surgical oncologist, presently the Director of Breast & Gastro-Intestinal Onco-Surgery at Fortis Memorial Research Institute (FMRI), Gurgaon. He has performed more than 12000 onco-surgical operations since 1996. He has successfully done various complex onco-surgical operations including laparoscopic and thoracoscopic procedures. He is also well versed in diagnostic and therapeutic endoscopic procedures.He has a keen interest in advancements in oncology and was an investigator in a phase III Clinical trial.
Dr. Pradeep Chowbey
Dr. Pradeep Chowbey is a world-renowned pioneering laparoscopic surgeon. With over 45 years of surgical experience, he has trained more than 20,000 surgeons from around the world in minimally invasive surgeries. He is one of the first to perform laparoscopic cholecystectomy in North India and the first to perform MAFT (Minimally Invasive Fistula Technology) in the Asia Pacific Region. He has graphed his career with singular determination to develop, evaluate, and propagate Minimal Access, Metabolic & Bariatric Surgery in India, and the Asian subcontinent.
Anal fissure treatment with anal dilatation
Anal fissure is a minor tear of the lining of the anal canal, which is usually created by constipation, hard stools, or non-healing strains. The symptoms consist of pain in the course of and following defecation, bleeding, and anal sphincter spasms.
Why Anal Dilatation Helps?
Relaxes sphincter spasm: Anal fissures tend to be aggravated by rigidness of the internal anal sphincter.
Enhances blood circulation: Canal stretching enhances blood flow to the fissure aiding in healing.
Makes the bowel movements easier: Trauma to the fissure is minimized during defecation.
Laser anal dilatation surgery in India
General anal dilation is associated with the stretching or the gentle enlarging of the anal canal / sphincter. This may be performed by hand or by devices usually to alleviate pain/spasm, aid with fissures, anal stenosis or tight sphincter problems.
Additional surgeries to fissure in ano, anal stenosis or tight sphincter may include cutting (sphincterotomy), laser ablation, or other less invasive techniques of fissures or fistulas.
Laser finds application in laser fissure surgery, laser fistula treatment, laser hemorrhoid/pile surgery etc. The laser assists in the reduction of bleeding, tissue trauma, less postoperative pain, faster recovery etc.
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