Walsall Manor Hospital has become the first NHS Trust in the Midlands to introduce two new procedures to relieve patients with a painful condition via keyhole surgery, and hopes to become a regional hub for the treatment.
Cancer Lead Mr Naseem Waraich and his team are now performing video-assisted anal fistula treatment where surgeons are able to look at the fistula tracts and treat them. A fistula is a tunnel that connects a gland to an opening. It is hoped the technique could see up to 50 cases per year treated.
Under the treatment, techniques can be carried out to fix a complex fistula, where a small tunnel develops between the end of the bowel and the skin near the anus, and a pilonidal sinus, which is an infected tract under the skin between the buttocks (the natal cleft).
Both procedures are completed as day cases. The complex fistula technique, which requires patients to have a general anaesthetic, takes 45 minutes to an hour, while the pilonidal sinus is done under local anaesthetic and takes about 30 minutes.
Mr Waraich said: “These procedures are keyhole surgeries and will change the outcome for patients by providing less pain, same-day discharge from hospital and an earlier return to everyday life. It will also help in quick recovery from surgery with less long-term effects.”
Consultant Surgeon Rajagangshan Raj, from St Helens & Knowsley Teaching Hospitals NHS Trust, Liverpool, performs around 50 cases each year and mentored Mr Waraich and his team as they performed the first cases at the Manor.
Mr Raj said: “It’s a new form of treatment which I feel has better results for the patients.
“Both techniques are what we call minimum access techniques which mean it can be performed through a very small hole, so the incisions we make are probably five or six millimetres, rather than the bigger cuts we used to make.”
Previously, patients would have a plastic tube inserted or surgeons would put a little sloop around the fistula so it drains out.
But this is not a permanent solution and can be quite debilitating, especially with younger patients and older patients who are quite active, and the new technique enables the fistula to heal.
Mr Raj believes the development is an important step for Walsall Healthcare NHS Trust, adding: “This is very significant. It’s not only good for Walsall Manor but good for the West Midlands because they can recruit patients from the whole area.”
Similar numbers of patients could be treated at the Manor as at St Helens & Knowsley, enabling Walsall to become a regional hub for the procedure, according to Mr Raj.
“Eventually I feel this will be a specialist hub for complex fistulas where these procedures will be undertaken,” he said. “My aim is to have a national network, so if I’m aware of a patient in Birmingham, I can say ‘go to my colleague in Walsall’. I see a lot more patients being referred.
“I know this works and one of the main reasons why I have come to train people up here is it’s so nice for the younger surgeons to take this on. It’s not fair on patients to travel long distances and it’s good to offer these services locally.
“The take-up (prior to this) has been low because people ignore the symptoms plus we have found lots of people suffer in silence because they think there are no treatment options available.
“But once patients realise the service is done here, more people will come here for it.”
The procedure also delivers a high success rate. “Around 80 per cent of the patients heal after one year, so the results are very good,” said Mr Raj.
Medical Director Manjeet Shehmar said: “I’m delighted and extremely proud that Walsall is the first Trust in the Midlands to offer this treatment. I’m sure we’ll see many patients coming forward to take advantage of this new service to be treated by Mr Waraich and his excellent team.”