Most symptomatic internal
hemorrhoids, grade 1 through 3, can be treated successfully with office-based procedures. Anorectal suppurative diseases must be treated surgically. Control of
sepsis with subsequent
fistula surgery as necessary is the goal. New nonoperative methods of
anal fissure therapy are directed at reducing anal sphincter pressures. These methods have shown significant reduction in the need for
sphincterotomy--a proven surgical technique with some risk of impaired continence. Surgery, using an advancement flap and partial
internal sphincterotomy, remains the primary treatment for anal
stenosis. Solitary rectal
ulcer remains a difficult problem to manage medically and surgically. Multiple surgical techniques can effectively treat
rectal prolapse. A minimal technique using
Silastic wrap (Wright Medical Technologies; Arlington, TX), perineal resection (Altemeier procedure), and sigmoidectomy-rectopexy, or Ripstein
suspension, has been the most favored method in selected patients.