Complications of Surgery of the Anal Canal

Diseases of the anorectum such as hemorrhoids, fissure-in-ano, fistula-inano, perianal abscess, and rectal prolapse are common presentations to general as well as gastrointestinal surgeons. The primary treatment often is conservative, with the exception of an abscess; however, a number of these patients need surgical intervention. Although surgery on the anorectum is often considered ‘minor’, the development of complications is not uncommon and can result in a considerable impact on the patient, surgeon, and healthcare system.
The anorectum is inherently exposed to shearing stress and strain during physical activity; it is rich in apocrine and sweat glands and is in direct contact with the fecal stream. In addition, the inherent difficulty of maintaining hygiene together with its visual inaccessibility hinders self-care. Temporary diversion stomas can overcome some issues if used selectively. Miller et al report the absence of a structured curriculum in the management of anal diseases which may contribute to the lack of a clear understanding of the anatomy, physiology, and pathology of the region contributing to the development of surgical complications.