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FISTULOTOMY When an anal fistula has developed and the course or the tract of the fistula has been determ ined from the anal canal to the perianal skin, and the surgeon has reassured themselves that there is not much anal m uscle below the fistula, in the expectation that with its division no anal or faecal incontinence will result, then a fistulotom y m ay be perform ed. This is fortunately the case for m ost fistul a that present. A fistulotomy usually involves dividing the skin, fat and m uscle between the skin and the two fistula openings, down to the tract of the fistula as it courses through the perianal and anal m uscle tissues. This is achieved with either a scalpel or an electro cautery dev ice. Depending on the type of fistula and wound, the surgeon may leave the resulting would open or “m arsupialise� (stitch the opened fistula tract to the skin edges) the wound with dissolv able sutures to aid wound healing. anal fissure You w ill be given specific instructions on the day of surgery, but they usually include regular warm salt or sitz baths, avoiding hard wiping of the area, the use of perianal pads, and taking of stool softeners, pain m edicine, fibre supplements and possibly a laxative. A nerve block in the area provides decent pain relief on the day , and m edications will be giv en to hopefully m inim ise pain or any ongoing discom fort. Following surgery there are risks of bleeding and infection, and longer term risks of inability t o control flatus of bowel m ovements, but it is best to discuss these with your doctor for m ore specific details related to y our fistula and y our planned surgery . Colonoscopy is an examination to inspect the inner lining of the large bowel (rectum and colon) using a flexible tube with a camera at its tip. It is inserted via the anus and gently guided to the start of the large bowel (caecum ). During colonoscopy, carbon dioxide gas is used to inflate the bowel to allow a safe passage of the colonoscope through the bowel. If an abnormality is encountered a tissue biopsy can be taken through the colonoscope and sent for histological examination. If poly ps are found, these small growths of the bowel lining can be rem ov ed with either cautery (hot biopsy ) or a wire loop dev ice (snare). This allows tissue to be retriev ed and sent for histological examination. Early detection and rem ov al of poly ps protects from dev eloping colorectal cancer.

A colonoscopy allows an examination of the entire colon (1200–1500 mm in length). A sigm oidoscopy allows an examination of the distal portion (about 600 mm) of the colon, which may be sufficient because benefits to cancer surv iv al of colonoscopy hav e been lim ited to the detection of lesions in the distal portion of the colon. div erticular disease What should I expect during colonoscopy procedure? During colonoscopy, patient will lie on their l back or left side. Patient is continuously m onitored for heart beat(rhythm) and blood pressure and oxygen in the blood. Medications are given through a intrav enous line so the patient feel relaxed. After tip of the colon or last portion of the sm all intestine is reached, the colonoscopy is withdrawn slowly, and the colon lining is carefully examined. Colonoscopy may often m ake you feel bloating and cramping in the abdom en area, but with the m edications pain becomes infrequent and tolerable. Generally , the colonoscopy procedure last for 15 to 6 0 m inutes; if the colon cannot be visualized properly, the physician can try colonoscopy again at a later date. Preparing for Colonoscopy : For the treatment of Colonoscopy , preparation is required prior the test to em pty the bowel of its content. Failure to do this m ay result in an incomplete or inadequate exam ination and the need to repeat the procedure. The preparation involves drinking a “bowel prep” solution which has a laxative effect. This should be done at hom e as y ou will need to be close to the toilet for the duration of the preparation. During the preparation y ou are not allowed to eat any solid food. You are allowed clear fluids (apple juice, water, clear soup, etc.) until 6 hours prior to the procedure. Only when your bowel motion is the consistency of clear liquid, is your preparation adequate. If y our bowel m otion is still dirty (brown) y ou m ay require further preparation or an enem a prior to the colonoscopy . You should fast from six hours prior to the procedure. Take all m edication as required with a sip of water during the fasting period. Taking care of y ourself at hom e after colonoscopy : General suggestions include the following : Do not driv e y ourself hom e after a colonoscopy procedure Don’t consum e alcohol, as it m ay interact with the m edications. Follow all dietary suggestions

Colonoscopy Procedure: When you arrive on the day of y our colonoscopy you will change into a hospital gown and an intrav enous line (drip) will be inserted into your arm. This will allow your doctor to give you intrav enous fluid and m edication. The procedure is done with sedation or a light anaesthetic. The procedure takes approxim ately 3 0-4 5 m inutes, but longer if polyps are removed or biopsies are taken. After the procedure y ou will need 1 -2 hours to recov er from the sedation or an aesthetic. You should have m inimal discomfort. You m ust not drive or operate machinery after your procedure and you will need a family member or friend to take y ou hom e. You will need to take two day s off for the procedure, one for the bowel preparation and the other for recov ery from the sedation and procedure. Colonoscopy is a safe procedure with a low risk of com plications. The most significant risk of this is a perforation of the bowel. The risk of this is approxim ately 1 in 1 000. If a biopsy or poly pectom y is perform ed the risk of bleeding from this is about 3 in 1000. In addition, although this is the best test for detection of cancer there is a sm all risk of m issing a sm all cancer. The risks and benefits of colonoscopy should be discusse d in detail with your doctor prior to proceeding with the test.

Our team of well trained colorectal surgeons are committed to the diagnosis and treatment of bowel cancer. Our surgeons consult from Roy al Prince Alfred Hospital (RPAH) Medical Centre, and if required organise procedures at RPAH and Sy dney Day Surgery . The specific details of y our colonoscopy bowel preparation will be discussed and given to you at the tim e of y our consultation.

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Colorectal surgeons in Sydney - We are renowned Colorectal surgeons who can help with diagnosis and treatment of bowel cancer.

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