• Joel Bauer MD
  • Stephen Gorfine MD
  • David Chessin MD
  • Daniel Popowich MD

Anorectal Procedures

Anorectal Procedures in Manhattan

Skilled Colorectal Surgeons

Hemorrhoids, fissures, abscesses, fistulas, and pilonidal disease should all be treated with the attention of a skilled surgeon to avoid painful problems in the future. At Manhattan Surgical Associates we specialize in anorectal procedures to help treat these issues and disorders.

Contact our Manhattan colorectal surgeons today to schedule an appointment. We can be reached at 646.798.4606.


Hemorrhoids are abnormally dilated tissue consisting of blood vessels, connective tissue, and smooth muscle. Symptoms include bleeding, itching, burning, pain, and no symptoms at all.

The initial treatment of hemorrhoids includes:

  • Dietary modification (increase fiber and liquid intake)
  • Stool softeners
  • Sitz baths (sitting in a warm tub of water)

For internal hemorrhoids, rubber band ligation or infra-red coagulation may be options. For more advanced internal hemorrhoids, excisional hemorrhoidectomy may be offered.

Preparation includes:

  • Taking nothing to eat or drink after midnight the night before surgery
  • Taking an enema the night before or morning of the procedure

The surgery requires general or spinal anesthesia or intravenous sedation, as well as local anesthesia for postoperative pain control. After anesthesia is established, the hemorrhoids are excised and the resulting wound is sutured closed. You will have a dressing placed over the operative site.

Postoperative care instructions include:

  • Taking pain medication and/or a stool softener
  • Taking warm baths to soothe
  • Keeping the operative site clean

In the one to two weeks following surgery, you will see your surgeon for a follow-up appointment. In the intervening time period, you should call your surgeon with any questions or concerns.

Internal Sphincterotomy for Anal Fissure

An anal fissure is a tear in the lining of the anal canal. Symptoms include pain that is worse during and after bowel movements and bleeding. The cause of an anal fissure is likely the passage of a hard stool combined with a tight internal anal sphincter muscle. The initial treatment includes dietary modifications (increase fiber and liquid in the diet) and stool softeners. Topical smooth muscle relaxants (such as Nitroglycerin and Diltiazem) may be used.

Another treatment option consists of injection of Botulinum toxin (BoTox) into the muscle surrounding the fissure. A procedure called a lateral internal sphincterotomy (in which a portion of the anal sphincter muscle is divided) may be recommended.

This involves cutting a portion of the internal anal sphincter muscle. It is usually performed as an ambulatory (same day) surgery. Preparation for surgery includes taking nothing to eat or drink after midnight the night prior to the procedure. Often no further bowel preparation is prescribed.

You will be given the following options for anesthesia:

  • General anesthesia, in which you are completely asleep
  • Local anesthesia for postoperative pain control
  • Spinal anesthesia, where the anesthesiologist places a catheter in your back to make the region of the fissure numb
  • Intravenous sedation

After anesthesia is established, a segment of the internal sphincter muscle is isolated and divided. You will have a dressing placed over the operative site.

Pain medication, warm baths, and keeping the operative site clean is crucial to your postoperative care.

Procedures for Perianal Abscess & Fistula

A perianal abscess is a collection of infected fluid surrounding the anus. Symptoms include pain, fevers, and the presence of a mass. The treatment is incision and drainage. Following drainage, 50% of patients will develop a fistula which is an abnormal connection between the inside of the anus or rectum and the skin.

There are many treatments for a perianal fistula, including a fistulotomy (incision of the fistula tract), closure with fibrin glue or a fistula plug, and closure with an anorectal advancement flap. In addition, initial treatment may include placement of a seton (rubber band that allows for drainage of residual infected fluid), followed by closure of the tract with one of the procedures listed above.

Preparation, anesthesia, and post-operative measures are similar to other anorectal procedures, and your colorectal surgeon will help care for you from pre-operation through the healing process.

Procedures for Anal Fistula

A fistulotomy involves cutting the tissue above the fistula to allow healing to take place. If fibrin glue is injected, the fistula tract is clean and the glue is injected into the tract to cause closure. A fistula plug is a soft roll of material made from a portion of a pig’s intestine. It is sutured into the fistula tract to cause closure. An anorectal advancement flap is created by dissecting the lining of the anus and rectum and suturing it over the internal opening of the fistula.

A seton may be placed to allow for drainage of the fistula tract. A seton is often made from a soft rubber band that is sutured to itself in a circular fashion to keep the fistula tract well drained. Once any infection is drained, one of the procedures discussed above may be chosen for closure of the fistula tract. You will have a dressing placed over the operative site.

Procedures for Pilonidal Disease

Pilonidal disease includes both a pilonidal abscess and a pilonidal cyst or sinus. The location of pilonidal disease is in the intergluteal cleft, between the soft tissue of the buttocks in the lower mid-line of the back.

Symptoms of a pilonidal abscess include pain, fever, and drainage in the intergluteal cleft. Symptoms of a pilonidal cyst or sinus include drainage and the feeling of a mass in the intergluteal cleft. The cause of pilonidal disease is not entirely known, but likely is due to the body’s reaction to trapped hair in the intergluteal cleft. The initial treatment of a pilonidal abscess includes incision and drainage and may require antibiotics. For pilonidal cyst or sinus, the treatment is surgical excision.

Incision and drainage of a pilonidal abscess is often performed to resolve the infection. It may be performed in the office, as an ambulatory surgery on an urgent basis or you may be admitted following the procedure.

After general, local, or intravenous anesthesia is established, the pilonidal abscess is drained by making an incision in the skin overlying the abscess. You may have a soft tube placed in the cavity that remains. You will have a dressing placed over the operative site and will be given pain medication and/or antibiotics.

If you are facing an anorectal procedure, email Manhattan Surgical Associates to learn more.

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