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About Us

We are one of the leading and oldest proctology centres in India established in the year 1930 at NAI SARAK, Delhi By Late Dr. Raja Ram Gupta. The centre is now located at Darya Ganj. The centre is being run by well-qualified Doctors. We are the pioneers in non-surgical day care treatment for Ano Rectal disorders ( Piles, Fissures and Fistula in Ano ). The centre attracts patients from all corners of the country and has facility for surgical, non-surgical and Laser treatment. Insurance Facility is available at partner hospital.

Treatment Facilities

Fissure in Ano

Fissure in Ano or Anal Fissure is a break or tear in the skin of the anal canal. It may be acute or chronic. Anal fissures usually extend from the anal opening and are usually located posteriorly in the midline, probably because of the relatively unsupported nature and poor perfusion of the anal wall in that location.

Cause of Anal Fissure

Fissures may be caused by constipation, the passing of large, hard stools, or by prolonged diarrhoea. In older adults, anal fissures may be caused by decreased blood flow to the area.Other common causes of anal fissures include childbirth trauma in women, Inflammatory Bowel Disease (IBD), poor toileting in young children. In rare cases, an anal fissure may develop due to anal cancer, HIV, tuberculosis, syphilis.

Symptoms –

  • Painful defecation

  • Bleeding per rectum or blood in toilet paper

  • Itching/ burning sensation

  • a skin tag, or small lump of skin, next to the tear

Treatment –

  • Medical Management – include stool softeners, topical pain relievers like Lidocaine, applying a ointment to the anus to promote blood flow to the area or a hydrocortisone cream to help with inflammation, high fibre diet and hot fomentation/ sitz bath.

  • Surgical Treatment - Surgical procedures are generally reserved for people with anal fissure who have tried medical therapy for and have not healed. It is not the first option in treatment. The main concern with surgery is the development of anal incontinence.Two of the common used procedures are Lateral Internal Sphincterotomy and Anal Dilatation (lord’s procedure)


Fistula in Ano

Fistula in Ano - Fistula in Ano is abnormal communication between anal canal and perianal skin lined by granulation tissue, secondary tracks may be multiple. Etiology - Crypto Glandular Hypothesis -Most of the fistulas originate from anal gland infections. Anal cryptic glands lie between the internal and external anal sphincter and drain into the anal canal.

The Cryptoglandular hypothesis states that an infection begins in the anal canal glands and progresses into the muscular wall of the anal sphincters to cause an anorectal abscess.Fistula in Ano can also develop secondary to trauma, malignancy, radiation, tuberculosis, inflammatory bowel disease etc.

Classification of Fistula –

High & Low Fistula
  • Park’s Classification
    Intersphincteric - 45%
    Transsphincteric- 30%
    Suprasphincteric – 20%
    Extrasphincteric - 5%

Signs and Symptoms -

  • Perianal discharge

  • Swelling

  • Skin excoriation

  • External opening

  • Diagnosis is made on the basis of Digital Rectal Examination and Proctoscopy.

Imaging (MRI) –

  • Not required for routine fistula evaluation

  • Primary opening is difficult to identify

  • Recurrent or multiple fistulae to identify secondary tracts or missed primary openings

Treatment –

  • Fistulotomy/Fistulectomy – are commonly used surgical techniques

  • Seton - Material inserted into fistula tract to encircle the sphincter muscles.There are two types of Seton’s – Draining or Cutting. Another type of Seton is Chemical seton( Ayurvedic ) k/aKsharsutra.Seton’s are used in treatment of High Fistula

  • Lift Procedure

  • Anorectal Advancement Flap

  • Other Procedures like VAAFT and Biodegradable material-Fibrin glue, Collagen plug have been used with variable success rates.

  • Laser Surgery.


Haemorrhoids (Piles)

Haemorrhoids (also known as Piles) are normal anal cushions that aid in stool control. They are a vascular structure in anal canal. They become a disease when swollen or inflamed; the term "haemorrhoid" is often used to refer to the disease.These are located classically at left lateral, right anterior,

and right posterior positions (i.e. 3,7,11 o’clock position) Haemorrhoids are very common.Males and females are both affected with about equal frequency.Internal haemorrhoids are far enough inside the rectum that you can't usually see or feel them. They don't generally hurt because you have few pain-sensing nerves there. Bleeding may be the only sign of them. External haemorrhoids are under the skin around the anus, where there are many more pain-sensing nerves, so they tend to hurt as well as bleed.Occasionally, a clot may form in a haemorrhoid (thrombosed haemorrhoid). These are not dangerous but can be extremely painful and sometimes need to be lanced and drained.

Signs and Symptoms -

The exact cause of symptomatic haemorrhoids is unknown. Multiple factors play role in development of piles. These include –

  • Irregular bowel habits (constipation and diarrhoea)

  • Increased intra-abdominal pressure – like in pregnancy, prolonged straining

  • Low fibre diet

  • Ageing

  • Some studies have incriminated genetics as a possible cause

  • Other risk factors like – lack of exercise, obesity, smoking, prolonged sitting etc.

Symptoms of Haemorrhoids –

  • Internal haemorrhoids usually cause painless bright red bleeding during or after defecation. Other symptoms may include mucous discharge, a perianal mass if they prolapse through the anus.

  • External haemorrhoids can become painful when thrombosed.

Grading of haemorrhoids –

  • Grade I – No prolapse, only dilated veins.

  • Grade II – Haemorrhoids prolapse but reduce spontaneously on its own.

  • Grade III – Haemorrhoids prolapse but have to be repositioned manually.

  • Grade IV – Haemorrhoid are permanently prolapsed and cannot be repositioned manually.

Treatment –

  • Conservative – includes high fibre intake, plenty of oral intake, sitz bath/hot fomentation, laxatives and topical agents.

  • Rubber Band Ligation – a rubber band is applied to haemorrhoid above the dentate line to cut off its blood.

  • Injection Sclerotherapy – an injection of sclerosing agent is given in the internal haemorrhoids which causes veins to collapse leading to shrinking of haemorrhoids.

  • Grade IV – Haemorrhoid are permanently prolapsed and cannot be repositioned manually.

  • Surgery – Excisional haemorrhoidectomy –is surgical excision of haemorrhoid. It is associated with significant post-operative pain. - Stapled Haemorrhoidectomy - it is associated with relative less post-operative pain and relative faster recovery than the conventional haemorrhoidectomy. Laser Surgery.

  • Laser Surgery.

  • Other procedures like infra-red have been tried with variable success rates.

Meet Our Specialist

ravi

Dr. R R Gupta

MBBS
Consultant Proctologist

ravi

Dr. Anshul Gupta

MBBS, MS (Surgery) , FICS

Consultant General & Laparoscopic Surgery

Max Multispeciality centre

Panchsheel Park, New Delhi

OPD (MAX) - MON, TUE , THUR, FRI 8AM - 10AM | WED 9AM - 11AM | SUN 11AM - 1PM

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