PRINCIPAIS TÉCNICAS CIRÚRGICAS PARA TRATAMENTO DE AFECÇÕES ORIFICIAIS: HEMORROIDA, FISSURA ANAL E FÍSTULA ANAL RESUMO

• DOI: https://doi.org/10.22533/at.ed.8208172508102

• Palavras-chave: indicações; hemorroidas; fístula anal; fissura anal; técnica cirúrgica.

• Keywords: indications; hemorrhoid; anal fistula; anal fissure; surgical technique.

• Abstract: Introduction: Hemorrhoidal disease, anal fissure, and anal fistula are highly prevalent anorectal conditions in medical practice and have a significant impact on patients' quality of life, who often complain of pain, bleeding, prolapse, and constipation. Although outpatient treatment is the first-line therapy for mild cases, more complex and refractory conditions usually require surgical correction. Objective: To synthesize and inform healthcare professionals about the indications and general surgical aspects of the main approaches to these proctologic conditions. Methodology: A bibliographic search was conducted in articles, books, and scientific documents from PubMed, SciELO, Google Scholar, and virtual libraries, published in Portuguese and English. Studies outside the scope, including treatment in pregnant women and pediatrics, were excluded. Results and Discussion: Hemorrhoidectomies, especially the excisional type, tend to have high success rates and low recurrence. Chronic and refractory anal fissures are preferably treated with internal lateral sphincterotomy, although sphincter- sparing alternatives may be used in selected cases. Simple anal fistulas are usually treated with fistulotomy, while more complex cases are reserved for sphincter- preserving techniques, such as seton placement or advancement flaps. Conclusion: The selection of the surgical technique for anorectal disorders must be individualized, considering the patient’s symptoms and anatomy, as well as their expectations, therapeutic effectiveness, and the functional preservation of anal continence. Mastery of the techniques and careful patient management are crucial for better clinical outcomes.