Recent changes in the management of proctological disorders

Proctological disorders are common and can significantly affect a patient's quality of life. This thesis aims to summarize current treatments for common proctological pathologies, such as hemorrhoidal disease, anal fissures, and pilonidal sinus, with a particular focus on recent developments in their management and assessment. Hemorrhoidal disease affects both men and women, with a high prevalence across populations. Symptoms range from discomfort and bleeding to prolapse and soiling. First-line conservative treatments include lifestyle modifications and oral medications. When these measures fail or provide insufficient symptom relief, instrumental approaches and surgical procedures may be considered. However, due to the heterogeneity in reported outcomes, identifying the optimal treatment option for individual patients remains challenging. Additionally, novel techniques, such as laser treatment, have emerged, although long-term follow-up data are currently lacking. Regarding the treatment of anal fissures, multiple approaches are available. Given the potential risk of anal incontinence associated with sphincterotomy, minimally invasive techniques, such as botulinum toxin injections or flap techniques, may be preferred. Notably, there are significant variations in medical practice, and the latest advancements in the field appear to be known primarily by specialists. Postoperative care plays a crucial role in the healing process, influencing both recovery time and the likelihood of recurrence, as in case of pilonidal disease. This condition is particularly prevalent among young men and can severely impact their daily social and professional activities. This thesis underscores the challenges faced by coloproctology surgeons in assessing patient expectations suffering from proctological disorders, integrating innovative treatment approaches into clinical practice, and disseminating knowledge to the broader healthcare community to ensure optimal patient care.