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Medicine Surgery

Relieving a pain in the posterior

I’ve been meaning to mention this post by Sid Schwab of Surgeonsblog for a while now. It’s a wonderful example of how nothing heals like surgical steel in even the most humble-seeming conditions. In this case, he’s talking about anal fissures, a condition that makes defecation very painful. It turns out that, for cases that won’t heal with conservative measures, there’s a very simple and underutilized operation that can be done in the office known as the lateral sphincterotomy, which can relieve the pain and in essence “cure” the condition instantly. Few operations provide such instant relieve. Unfortunately, it’s an operation that’s far too often not done, either because patients with an anal fissure aren’t referred to a surgeon as their docs endlessly try to treat the condition with soaks and stool softeners beyond the point that it’s clear that the fissure won’t heal or because many general surgeons were never really trained in the procedure.

When I was a resident, I once asked a colorectal surgeon why he had gone into the specialty, given the frequent contact with stool and staring up people’s behinds. His response was instructive. He told me that being able to defecate normally is something most people take for granted but that’s highly disruptive to a patient’s quality of life and that if you can fix a patient’s problems pooping that that will be the most grateful patient you’ve ever seen. The results of a lateral sphincterotomy were one of the things that opened my eyes to the truth of his words.

It wasn’t enough to inspire me to become a colorectal surgeon, though.

By Orac

Orac is the nom de blog of a humble surgeon/scientist who has an ego just big enough to delude himself that someone, somewhere might actually give a rodent's posterior about his copious verbal meanderings, but just barely small enough to admit to himself that few probably will. That surgeon is otherwise known as David Gorski.

That this particular surgeon has chosen his nom de blog based on a rather cranky and arrogant computer shaped like a clear box of blinking lights that he originally encountered when he became a fan of a 35 year old British SF television show whose special effects were renowned for their BBC/Doctor Who-style low budget look, but whose stories nonetheless resulted in some of the best, most innovative science fiction ever televised, should tell you nearly all that you need to know about Orac. (That, and the length of the preceding sentence.)

DISCLAIMER:: The various written meanderings here are the opinions of Orac and Orac alone, written on his own time. They should never be construed as representing the opinions of any other person or entity, especially Orac's cancer center, department of surgery, medical school, or university. Also note that Orac is nonpartisan; he is more than willing to criticize the statements of anyone, regardless of of political leanings, if that anyone advocates pseudoscience or quackery. Finally, medical commentary is not to be construed in any way as medical advice.

To contact Orac: [email protected]

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