Cutting Edge | How to cure fistula permanently?

Pune colo-rectal surgeon Dr Ashwin Porwal has developed the minimally invasive DLPL technique to treat complex fistulas

For 12 long years, US-based Julie Rogers suffered from a Grade 5 super complex fistula. Her personal health challenges made her seek a series of treatments that unfortunately did not offer long-term relief. She had no idea what to expect though when she arrived in Pune in July where Dr Ashwin Porwal and his team’s “healing hands” performed the Distal Laser Proximal Ligation (DSPL) procedure and freed her from pain.

There are various kinds of fistula and Dr Porwal’s patients vouch for a cent per cent cure. Take for instance Pune’s Dr Saloni Joshi who developed an obstetric fistula – a hole between the birth canal and bladder and/or rectum caused by prolonged obstructed labour – but was cured completely.

WHAT IS A COMPLEX FISTULA?

An anal fistula is a small tunnel that develops between the end of the bowel and the skin near the anus. “Fistula-in-ano is one of the most commonly encountered surgical problems with the prevalence of average 2/10,000,” says Dr Porwal, founder of Healing Hands Clinic in Pune and a noted colorectal surgeon who specifically designed the Distal Laser Proximal ligation procedure for highly complex anal fistulas.

The condition has been known since ages and different management techniques for it have been suggested in medical literature. But it continues to be one of the most challenging clinical problems in anorectal surgery.

Various surgical interventions have had variable success. The surgical management of complex fistula is usually aimed at the permanent elimination of the suppurative process by drainage of sepsis and removal of fistula tracts while maintaining sphincter integrity.

Recently, the Indian Journal of Colo-Rectal surgery has concluded that minimally invasive, sphincter-saving DLPL surgery is safe and effective treatment for complex fistula‐in‐ano. “This is a minimally invasive sphincter saving surgery for complex fistulas. Basically it addresses the intersphincteric space which is the root cause of complex fistula,” says Dr Porwal, who has performed 4,661 such surgeries till date. In Julie’s case, an inflammatory bowel disease (Crohn’s disease) led to the fistula developing between one loop of intestine and another.

WHAT IS THE DLPL SURGERY?

Dr Porwal explains that the DLPL is based on two principles. One is debridement, which is a procedure for treating the wound on the skin. Inefficient debridement is one of the causes of recurrence in fistula. This is achieved in a minimally invasive way by using a laser, which takes care of the fibrosis associated with complex fistulas. The debridement is thorough and deep with the use of a laser, which can be easily negotiated within the Intersphincteric space and supralevator space.

The other principle is the efficient drainage from the fistula in the first two to three weeks which is the key to success in curing it after surgery,” he says.

DLPL is performed under the guidance of a 3D EndoAnal Imagine machine which can identify hidden fistula tracts and micro abscess in real time during surgery. That is the key in getting assured results with surgery. It also minimises the risk of damage to sphincter muscles.

Widening of the external opening serves that purpose while superficial incision over the internal opening helps in proper drainage in the initial three weeks after surgery. This is achieved by timely follow-up planned at five days, two weeks, four weeks and six weeks. “That is the reason why DLPL is associated with a negligible recurrence rate,” Dr Porwal says.

There is no need for daily dressing with DLPL and the patient can resume work in about five days. There is also no risk of incontinence as sphincter muscles are not incised, says Dr Porwal, who has trained over 250 surgeons in the country and worldwide.

 

DLPL laser technique brings down incontinence, recurrence rate in highly complex anal fistula patients

DLPL laser technique

Long-term follow-up of 683 operated patients shows a 99% success rate

Whether he would lose bowel control was one thing that weighed heavily on Ankit’s mind prior to undergoing surgery for anal fistula. “It has been more than two years now. I am completely fine post-surgery,” said Ankit, a software professional.

Ankit was part of an observational study comprising long-term follow-up of 683 operated patients with complex anal fistula for 30 months.

The study has shown that a minimally-invasive laser surgery technique can cure patients with complex anal fistula without causing bowel/anal incontinence – a known postoperative complication. The surgical technique also significantly reduces the recurrence rate which is very high in patients with anal fistula.

“Anal fistula is often considered a dilemma because of postoperative incontinence and recurrence rate. Using a distal laser proximal ligation technique (DLPL) – a minimally invasive sphincter-saving surgery, we could address anal incontinence and recurrence in 99% of our operated patients,” said Pune-based colorectal surgeon Dr. Ashwin Porwal.

Dr. Porwal’s study got published in a reputed index journal – Indian Journal Of Colorectal Surgery – recently.

Patients with anal fistula harbor apprehension of developing anal or bowel incontinence post-surgery. The bowel incontinence ranges from an occasional leakage of stool while passing gas to a complete loss of bowel control. It can significantly impact the quality of life.

“The goal of the surgery is a balance between getting rid of the fistula while protecting the anal sphincter muscles, which could cause incontinence if damaged. The DLPL technique deals with the root cause of complex fistula that is the internal opening and inter-sphincteric abscess,” Dr Porwal said.

DLPL is specifically designed for highly complex anal fistulas. “That’s why it has a 99 % success rate even in patients with type 4 complex anal fistula,” Dr. Porwal said.

Core principles of the DLPL technique are accurate diagnosis based on a 3D endoanal imaging probe, adequate debridement of the fistula tract with a radial Laser fiber, efficient drainage of the abscess in the first three weeks post-surgery, and excellent post-operative wound care.

“Follow-up after surgery is the key to success. A minimum of three follow-ups are required. First at 2nd week, then 5th week and finally at 8 weeks,” he said.

When probed why the study did not compare DLPL results with other laser treatments meant for anal fistulas, Dr. Porwal said, ” Ours is the only published study till date on highly complex anal fistulas with use of laser. Most of the studies – available for laser treatment in fistula – are for moderate cases but not specific to type 4 or highly complex cases.”

Every study has certain limitations. “In our case, it was a single-center study. But very soon we are planning to do a multiple center study. Adequate training of the surgeons is a must before that,” Dr. Porwal said, adding, “To date, we have operated on more than 5,500 cases of complex fistula. Very soon we will be publishing the results of our long-term follow-up study of operated patients for five years.”

Dr. Jaya Maheshwari, a senior member of the Indian Association of Gastrointestinal Endosurgeons (IAGES) Jaipur was the first surgeon outside Pune to get trained under Dr. Porwal in 2014. “I have performed DLPL technique on more than 200 patients with highly complex anal fistula by now with a similar success rate of 98-99 %,” Dr. Maheshwari said.

BOX

Why the study?

The surgical management of complex fistula carries a greater risk of incontinence, due to the involvement of the anal sphincter muscles

There are many surgeries performed for complex anal fistulas, but their success rates are variable

There is no single technique that can be called a gold standard in managing complex cases

The surgery with good-postoperative healing, with minimal or no functional loss, and less recurrence is need of the hour

This study was conducted to evaluate the efficacy of a novel technique, DLPL surgery, in the treatment of complex anal fistula

This study aimed to objectively assess the impact of operative treatment using the DLPL technique on quality of life-related to anal incontinence, recurrence

The study design

The study Included 683 operated patients of highly complex anal fistula with the DLPL technique between January 2013 and December 2017 with a minimum long term follow up of over 30 months

Most of the patients were working in the IT industry

Most of the patients were discharged the next day of surgery

The average time required to resume normal activities was less than a week

The overall success rate of the DLPL technique was 98.98% with a minimum long-term follow-up period of 30 months

Complete healing time was average 10 weeks for most of the cases

The study has concluded that the DLPL technique is minimally invasive,sphincter-saving, and has a negligible recurrence rate

Download PDF

Path-breaking Laser Technique for Fistula Treatment

With the medical field flourishing at a steady rate, healthcare has been witnessing a radical change in the way we approach treatment of various diseases. A lot of these advancements are further supplemented by unparalleled medical expertise and that is exactly whatsuper-speciality Proctology centre Healing Hands Clinic offers to all its patients. Proctology is a branch of medicine that deals with anorectal conditions like Piles, Fistula, Constipation, Fissure, Pilonidal Sinusamongst others. Healing Hands is India’s first chain of Proctology clinics offering cutting edge treatment options to patients suffering from these ailments. Each clinic is a state-of-the-art centre headed by an expert Laser surgeon with considerable experience in treatment of aforementioned conditions.

Of all anorectal disorders, an Anal Fistula is undoubtedly the most challenging to treat as recurrences are quite common. In this condition, an abnormal communication develops between the rectum/anal canal and the outer skin. This is where the expertise and experience of surgeons at Healing Hands comes in handy. Founded by renowned surgeon Dr Ashwin Porwal, all the procedures done at Healing Hands are Laser based, well-researched and backed by sound medical knowledge. For Simple Fistula, a technique called FiLaC – Fistula Laser Closure is used. For Complex and Recurrent Fistula, an innovative, sphincter-saving technique called DLPL – Distal Laser Proximal Ligation is used.These Laser based techniques ensure complete recovery and have a negligible chance of recurrence. Besides, they have a reputation of faster healing, minimal complications and a quicker return to normalcy for the patient. Statistics so far state thaton an averagethere is about 30% chance of recurrence in treated cases of Fistula. However, at Healing Hands, the numbers are at a mere 2% which clearly exhibits a sturdy success rate of the surgicalexpertiseoffered at this holistic clinic.In fact, Healing Hands is well known worldwide for treatment of highly complex and recurrent cases.All operated patients are thoroughly followed up until complete cure.

DLPL technique that was developed by Dr Porwal is an innovative procedure for complex and recurrent cases. The sphincter muscles remain safe and the patient does not run a risk of post-operative loss of control over motions (incontinence). Healing Hands Clinic has published a research paper on a series of 100 patients with Complex High Fistulas treated with DLPL in which there was not a single case of recurrence or Incontinence.

Anorectal Problems And How You Can Solve Them – Healing Hands Clinic, Your One-Stop Shop For All Your Proctological Solutions

What is an anorectal problem?

An anorectal problem is an internal condition that causes pain in the lower portion of the rectum. In the modern world, it is often used to describe an internal condition that causes problems with the bowel, including hemorrhoids, diverticula, and anal fissures. They can be related to either an injury or a disease and can be diagnosed through clinical evaluation.

Who is a proctologist, and what is proctology?

Proctology is the branch of medicine that focuses on the study of the pelvic floor (rectum/anus). It is the name given to the entire field of pelvic medicine, which is concerned with the care of the pelvic organs (rectum/anus) and their functions. It includes an anorectal examination, which is used to detect the presence of an internal disorder. Proctology is the study of the anorectal region. It is a medical specialty that deals with the external and internal parts of the body, including the prostate, bladder, and rectum.

A proctologist is a medical professional who is trained to operate on the inside of the body, particularly the rectum, and the outside of the body, especially the prostate. The term proctologist means a physician or surgeon who has trained in this specialty. In a medical sense, proctology is a subspecialty of surgery and is a specialization of medicine.

A common mistake patients make is going to the wrong kind of doctor :

Patients often go to the wrong doctor instead of a proctologist. This is often because the doctor who is trained to perform the examination does not know what is wrong and does not have the necessary skills to help the patient. This is especially true for patients who have experienced rectal pain and bleeding. There are several methods of diagnosing rectal pain and bleeding. It is important that one always visits a proctologist if they suspect they have an anorectal problem.

Patients often visit fake doctors or ‘quacks’ in the hope that they can get a quick fix to their problems. This often causes more harm than good,

Common symptoms of anorectal problems

● Bleeding from the rectum
● Constipation
● Anal pain
● Lumps
● Problems with passing stool
● Abscesses

What Healing Hands Clinic is the best choice for you

Our clinic tackles your problems differently right from the get-go. We pride ourselves on inpatient care. Our clinic is the best choice because we provide the best possible care for your problems. We diagnose the problem and offer you the best treatment. Our medical professionals are trained to detect and treat any type of anorectal problem. Our doctors are the best-trained in the diagnosis and treatment of anorectal problems.

Here is what makes us different :

1. You are welcomed and made comfortable when you arrive
We pay attention to your comfort and care throughout your appointment-making process

2. You are assigned a caring buddy.
A care buddy is a trained assistant doctor who will be your point of contact while you heal. In fact, they will be in touch with you for up to 5 years after your procedure to ensure you are doing well.

3. A proctologist is assigned to you.
A super specialized doctor is assigned to take care of your case. They will grade the severity of your illness. Our doctors will treat you with in-house medication that is herbal and causes minimal side effects to the body.

4. Painless proctoscopy
In the event that you need a proctoscopy, we promise it will be painless. Most proctoscopies, if done elsewhere, will tend to hurt. However, we have ensured that we created a method to conduct this procedure as painlessly as possible.

5. Recurrences are negligible
In anorectal cases, recurrences are common. However, we ensure that the margin for recurrences is negligible. In the extremely unlikely event that some sort of problem does recur (within five years of the procedure taking place), we treat it for free.

Overall our physicians are the best choice for your anorectal procedure. We have built a comprehensive network of physicians and specialists who treat your problem. We are really the best choice for all your proctological procedures, and we ensure that you will have the smoothest possible with us.

Emergency Surgeries during Covid

One of the challenges in health care during the ongoing covid-19 pandemic has been emergency surgeries. In a time wherein there was no clear guideline, managing emergency surgeries was a huge challenge. There were papers from the western world suggesting 25% morbidity in surgeries during the covid pandemic. The guidelines on pre-op testing for covid 19 were not clear.

There is tremendous fear amongst patients to seek immediate medical consultation during the ongoing pandemic. As a result of this most of the patients are presenting at the hospital in late-stage or severe pain.

This was noticed in the majority of the patients during the lockdown period. This was noticed in patients suffering from piles & fistula.
“Almost all the piles’ patients presented with severe pre-rectal bleeding or in severe pain,” says Dr Ashwin Porwal.
They were operated on with minimally invasive Laser Haemorrhoidoplasty under universal precaution.

“Many patients of Fistula in Ano presented with abscess due to late presentation. They were operated under emergency with minimally invasive DLPL laser surgery for fistula”, says Proctologist Dr Ashwin Porwal at Healing Hands Clinic.

There were 4 cases of Fourniers gangrene with uncontrolled diabetes with early sepsis. Emergency ambulance pick-up was arranged for such patients during the lockdown. Early surgery could prevent severe sepsis with faster recovery, Says Surgeon Dr Paresh Gandhi.

“All patients were operated under spinal anaesthesia to decrease the risk of transmission due to covid pandemic”, says anaesthetist Dr Nitin Nachane.

“Open 3D mesh repair was preferred over the laparoscopic repair for obstructed hernia considering the greater risk of transmission during the covid pandemic”, says Laparoscopic Surgeon Dr Deepak Kulkarni.

Many of the outstation patients who were operated on in early March for complex fistula couldn’t come for follow up due to lockdown. They developed premature closure of the wound. Which eventually developed into pus leading to an abscess. Evaluation under anaesthesia was performed on all such cases to drain the pus. This normally would not have happened if the follow-up dressing was not skipped.

Contracting Covid from asymptomatic patients is always a risk amongst health care workers. To minimise this strict universal precaution were taken. As a result of this none of the hospital staff contracted covid 19.

Universal Precautions for Covid
1.PPE kits were used for OT staff
2.Social distancing was maintained throughout from consultation to surgery.
3.Sanitisation was practised from door to door
4.Daily sanitisation of Rooms and hospital
5.Private rooms were allocated to all patients.
6.Only one attendant per patient was allowed
7.Patients were trained to use the mask in the right way.
8.Screening of all patients before entering the waiting room. History of travel, cough, fever was ruled out. Temperature and SPO2 check for all the patients on admission

Source: Healing Hands Clinic

One such case with uncontrolled diabetes presented in a very late stage due to lockdown.
The patient was suffering from a complex recurrent fistula for the last 1 year.
Excessive sitting at one place and limited activity due to lockdown was the possible cause for his recent increase in blood sugar levels. He started having pain in the buttocks 5 days before coming to us in an emergency. He self-treated the condition considering it as piles. Severe pain with fever prompted him to visit us. He underwent emergency FiLaC surgery for fistula and the abscess was drained. He took a longer time for the healing.

Questions & Answers
1.Why patients with piles and fistula who did not seek medical care during lockdown are taking a long time to heal now?

Answer : Usually 70% of patients coming to us for piles are treated with medicines and diet as they are diagnosed in an early stage. But now they are presenting in the late stages of the diseases with symptoms like severe pain or bleeding. Once the piles are in grade 3 or grade 4, medical management has a limited role. We are offering them Laser Surgery for same.
Patients with fissure who will normally respond to medications in 2 weeks are now taking minimum of 4-6 weeks for recovery with medications.
Patients suffering from Fistula are presenting in severe pain or fever due to abscess. Such patients need emergency surgery. But because of the active infection, healing is slow after surgery. Few complex cases might take 2-3 Months for complete healing after complex fistula surgery. Few patients need weekly follow up after fistula surgery but they are scared to travel due to lockdown. All these factors delay the healing and recovery time.

2.How seeking medical care in time helps in faster recovery?

Answer : Early diagnosis is the key to medical success and good quality of life. If piles are diagnosed in grade one or early grade 2 they can be cured with a specialised kit called PILOKIT which is 15 days course. It consists of innovative pilospray for instant relief without touching the sore anus. Pilotab for inflamed piles and Constitab for constipation.
Also, the uncomplicated fistula will heal very fast with laser surgery.

3.What are the various types of complications that patients with piles and fistula land up with when they delay treatment?

Answer : Patients in grade 3 and grade 4 piles will land up in severe per rectal bleeding with drop-in Haemoglobin. We saw many patients in bleeding who were having comorbid cardiac conditions and were taking blood thinners.
Few patients with abscess in existing fistula presented with early sepsis due to uncontrolled diabetes.
Few patients presented in severe sepsis with a morbid condition Called as Fourniers gangrene.

4.Is there any subset of patients who could have recovered with conservative treatment but now they had to undergo surgery as the disease progressed due to delay in seeking medical care during a lockdown ?

Answer : Most the patients with Acute fissure if treated in time are cured with medications.
But untreated fissure with severe pain or when it gets complicated into abscess or fistula will need surgery.

Dr Ashwin Porwal
Consultant ColoRectal Surgeon
Founder Healing Hands Clinic

Complications rise among piles patients in shutdown

Complications rise among piles patients in shutdown

A sizable number of people with piles and fistula are taking longer to get cured as most of them are delaying medical care in the wake of the coronavirus triggered lockdowns, resulting in complications.

“Usually, 70% of patients with piles are treated with medicines and dietary changes as they get diagnosed in an early stage. However, owing to the extended lockdown in the wake of the Covid-19 pandemic, a sizable number of patients are presenting in late stages of the disease with symptoms like severe pain and bleeding,” said consultant colorectal surgeon Ashwin Porwal of Healing Hands Clinic.

Once the haemorrhoids (piles) are in grade III or IV stages, medical management has a limited role.

“Most of these patients with progression of piles are being treated with laser surgery when medication and lifestyle modifications could have been enough to do the trick if they had approached us early,” Porwal said.

Similarly, patients with an anal fissure, a small tear or crack in the lining of the anus, who normally respond to medications in two weeks are now taking a minimum of 4-6 weeks for recovery with medications. “Patients with fistula, a tunnel that runs from inside the anus, are also approaching us after developing severe pain or fever due to abscess (collection of pus). Quite a few of them even required emergency surgery,” Porwal said.

Many of the outstation patients who were operated in early March (before the lockdown) for complex fistula couldn’t come for follow up due to the lockdown.

“They developed premature closure of the wound, which developed into pus leading to an abscess. This would not have happened if the follow-up dressing was not skipped,” laparoscopic surgeon Deepak Kulkarni said.

Healing is slow in such patients even after surgery.

“Patients need weekly follow up after surgery. But the frequent lockdowns made them reluctant to venture out for follow up, delaying the healing and recovery,” said anaesthetist Nitin Nachane.

Contracting Covid-19 from infected but asymptomatic patients is always a risk for healthcare workers as much as other patients.

“To minimize this, strict universal precautions are being taken. Post-surgery, patients are put on immunity-boosting medications like Curcumin and vitamin D for two weeks. None of our patients have developed Covid-19 during hospital stays and even after the surgery so far,” Porwal said.

Experts also stressed against indulging in self-medication amid Covid-19 infection fears.

“It is always better to reach out to the medical practitioner via online or video chats or simple call,” an expert said.

Reference

Pruritus Ani: The Embarrassing Itch

Itching of the skin around the anus can be agonizing especially if one is stranded in a public place with no escape in view. More often than not the cause behind this itch is easily addressed. Occasionally however, persistent severe itching can cause psychological stress to the sufferer and needs in-depth evaluation.

What is Pruritus ani?
Pruritus ani is defined as chronic, moderate to intense itching of the skin around the anal opening.
It affects 1-5% of the population and is more commonly found in men. Once itching occurs, it can lead to a vicious itch-scratch-itch cycle.

Causes of Pruritus ani

Fecal Contamination

Prolonged contact of the skin with fecal matter can cause irritation with resultant pruritus. Inadequate cleansing can leave stool and sweat residue which acts as irritant. Most of these individuals have loose stools or mucous seepage. Abnormal anal sphincter relaxation can also cause soiling. This kind of itch is usually relieved by washing the area. However, underlying pathology, if any, needs to be addressed.

Anorectal disorders

Anorectal conditions like Hemorrhoids (Piles) and Fissure can precipitate peri-anal itch. External hemorrhoids that are large can interfere with post-defecation cleansing. Internal hemorrhoids, on the other hand, can cause mucous seepage or fecal soiling and resultant pruritus. Anal Fissures can also cause itching due to inflammation. Anal Fistula or Fistula-in-ano with an external opening in the region, can lead to discharge of pus or fecal matter and consequent itching.

Infections

Fungal infections are common in the area, especially among diabetics who are prone to Candidiasis. Infection with threadworms/pinworms is also common, especially among children. Viral infections can also cause pruritus

Allergy

Chemicals found in creams, wet wipes, soaps etc. can cause Allergic Contact Dermatitis.

Skin conditions

Psoriasis, lichen sclerosis, Paget’s disease, peri-anal Bowen’s disease etc. can also can pruritus ani.

Other factors

Certain foods like caffeinated drinks, spices, peanuts, tomatoes etc. can cause peri-anal itching. Relief is attained within 2 weeks of stopping the causative food.
Aggressive cleaning can cause dryness of the skin and thus itching.
Psychological factors like anxiety, stress or depression maybe associated with pruritus ani.
Similarly, aggressive cleansing can cause dryness in the area and itching.

Dealing with Pruritus ani

To get rid of peri-anal itching, the underlying cause needs to be addressed. One should wear loose, cotton clothing, especially at night, which gives an opportunity for ventilation. Following a bowel movement, the area should be gently cleaned with water or simple tissue moistened with water or with peri-anal wipes. One should avoid the use of soaps in the area. Associated symptoms, if any, point to an underlying pathology. Anorectal conditions like piles, fissure and fistula are treated by a Proctologist. Peri-anal skin conditions, infections and allergies are treated by a Dermatologist.

Novel Laser Cure for Anal Fistula

Fistula-in-ano, a silent yet agonizing ailment, has always posed a treatment challenge to surgeons worldwide. The refractory nature of Fistula along with its tendency to recur continues to leave the best doctors perplexed. Consequently, those suffering from this condition find themselves anxiously searching for a definitive cure. In light of this scenario, Dr. Ashwin Porwal, renowned Proctologist and founder of Healing Hands Clinic, India, set out on devising a technique called DLPL that provides an assured and lasting cure.

Anal Fistula aka Fistula-in-ano is an abnormal track that forms between the anal canal and the skin around the anus. It is commonly associated with a collection of pus in the bottom area called Rectal Abscess. Symptoms may be due to the underlying Abscess or due to Fistula per se. This includes throbbing pain, oozing of pus/watery fluid, swelling, itching and foul odor. Diagnosis is confirmed by a simple test called Proctoscopy. For a detailed study of the abscesses and track branching, Dr. Porwal introduced 3D Endo-anal Imaging. This imaging can also be used intra-operatively thus increasing the precision of the surgery.

Until recent times, Fistula was treated using different techniques like Fistulectomy, VAAFT, LIFT, Ksharsutra, Fistula Plug etc. However, these conventional techniques were quite painful or had high recurrence rates. Being a Proctologist, Dr. Porwal would come across a large number of previously treated Fistula cases who were rendered helpless after recurrences. Subsequently, he developed his own technique DLPL (Distal Laser Proximal Ligation). In this procedure, any abscess cavity along with the internal opening is first excised. This is followed by the closure of the distal tract. The proximal part of the fistula track is then sealed with the Laser energy. With the radially emitting fiber of the laser, energy is applied circumferentially to the track ensuring it’s complete ablation. Complete healing takes about 8 weeks on average.

Using this technique Dr. Porwal has treated Complex and Recurrent Fistulae with noteworthy success. Patients from across the globe come to Healing Hands Clinic in the hope of a cure. Dr. Porwal has presented numerous research papers at national and international conferences. The benefits of DLPL will definitely bring hope to despondent patients of Fistula who muddle along for years in search of a cure.

Understanding Constipation and It’s Treatment

Constipation and It's Treatment

With a lot of humor centered around it, constipation is as much a topic of laughter for the audience as it is an agony for the sufferers. Constipation, basically, is a change in your normal bowel movements; going less frequently than you usually do, passing hard, dry stools, or straining when you defecate. In chronic cases it can lead to complications like piles, fissure and prolapse, and hence choosing to seek advice is much wiser than accepting it as an inevitable pattern of your digestive system.

A lot of times attempts at getting rid of constipation fail as treatment is unidimensional, being directed only towards the obvious reason, when it is in fact,caused by an array of factors. Taking this into consideration, Healing Hands Clinic, a comprehensive center for digestive diseases offers a multi-pronged approach for curing constipation. For those in whom it is caused by an unhealthy lifestyle, there is MCDPA, a treatment strategy formulated by Dr Ashwin Porwal, Founder of the clinic and amongst India’s leading proctologists. This therapy includes a combination of herbal laxative medicines, nutrition counselling, physiotherapy to strengthen the muscles of the pelvic floor and Ayurvedic oil therapy. This treatment strategy proves extremely beneficial when followed with compliance. For those in whom constipation is an occasional problem or who are seeking a detox, there is Colon Hydrotherapy, a cleansing technique that uses temperature and pressure-controlled water to flush out the intestines. The clinic is further equipped with Biofeedback Therapy to train the pelvic muscles for proper evacuation.

Dr Porwal, who introduced 3D Endo-anal Imaging in India says that this test helps to diagnose more complicated causes in chronic sufferers. In cases where there is an anatomical problem like rectocele or for those having Obstructed Defecation Syndrome, there is hope in the form of STARR surgery, a technique that provides excellent results.


For appointments:

Healing Hands Clinic
Pune Station / Tilak Rd: 88882 88884
Wanowrie: 88885 22226
Baner: 88886 22221
Chinchwad: 88882 00004
Chakan: 88882 96666
Kothrud: 85759 99993
Website: www.healinghandsclinic.co.in
Email: info@healinghandsclinic.co.in

Laser to cure pilonidal sinus

Laser Cure Pilonidal Sinus

Extended hours of sitting, either in front of the computer or preparing for competitive exams has led to rise in the incidence of Pilonidal Sinus amongst youngsters. Notoriously called as Jeep Driver’s Disease, this condition that is found in the tailbone area, is now a trouble for the young urban population. Proctologists at Healing Hands Clinic shed some light on this topic.

What is a Pilonidal Sinus?
The word Pilonidal means a nest of hair within a sac, whereas sinus tract is a narrow passage anywhere within the body. Thus, Pilonidal Sinus is a cyst (small sac) or tunnel in the skin that usually develops over the tailbone at the top of the cleft between the buttocks. The cyst usually contains hair and debris.

What are the causes of this condition?
The condition is more common in males, especially young adults. It’s seen in people who sit for long hours at a stretch, for ex. students, IT professionals, drivers. Men with thick, curly and coarse body hair are especially susceptible. Having a deep cleft between the buttocks also makes one prone to it. Obesity and family history are other causes.

What are the symptoms?
A person suffering from Pilonidal Sinus would usually have recurring episodes of pain or swelling in the tailbone area. There may be a yellowish pus-like or bloody discharge that may be foul-smelling. Sometimes, there is no discharge but a painful lump under the skin of that area. Certain activities like riding a bicycle or doing sit-ups may be uncomfortable.

How is it treated?
Thanks to advances in medicine, Laser is proving an excellent modality of treatment. The procedure called Laser Pilonidotomy is minimally invasive with faster wound healing as compared to the older techniques. Patients are discharged home the same day; they can perform all their chores and join office by the next day.

Healing Hands Clinic is certified Centre of Excellence in Proctology by world-renowned colorectal surgeon, Dr Antonio Longo.

For appointments:
Healing Hands Clinic
Pune: 8888288884
Navi Mumbai: 88881 66667
Mumbai: 8888266664
Nasik: 8888366662

Website: www.healinghandsclinic.co.in
Email: info@healinghandsclinic.co.in