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.