Excision of Lesions of the Anus or Rectum

Initial consultation

During your initial consultation for a perianal excision or destruction of an anal or rectal lesion, your colorectal surgeon will begin by reviewing your medical history, including current symptoms, prior procedures, and any relevant family background. You’ll be asked about things like rectal bleeding, pain, changes in bowel movements, and recent weight changes. A physical examination, including a digital rectal examination, is usually performed to assess the area. If you’ve had recent investigations such as a colonoscopy, sigmoidoscopy, or imaging (like MRI or CT scans), these will be reviewed to better understand the lesion’s size, location, and nature. Your doctor will explain the type of lesion found—whether it’s benign or potentially cancerous—and go over any biopsy results if available. From there, they’ll discuss whether a local approach, such as perianal excision or lesion destruction, is suitable for you, and talk through the benefits, risks, and what each option involves.

Preparation for surgery

Preparing for procedures like perianal excision or anal lesion destruction typically involves less intensive preparation than major rectal surgery, but some steps remain essential. You may be advised to follow a light diet or use a mild bowel prep to ensure clear visibility during the procedure, especially if a sigmoidoscopy is involved. Prophylactic antibiotics are often given to prevent infection. Lifestyle changes like smoking cessation and good nutrition are encouraged to support healing and minimise complications. Your healthcare provider will guide you on pre-op medication adjustments and give instructions on arriving for your day surgery.

Procedures for excision of rectal and anal lesions are minimally invasive and typically performed under general or regional anaesthesia.

Rectal lesion excision involves surgically removing the lesion through anal canal, often using special instruments to ensure precision, especially if a sigmoidoscope is used for visual guidance. It’s generally chosen for well-defined, early-stage, or benign lesions located in the lower rectum.

Destruction of lesions of the anus refers to techniques like cauterisation, cryotherapy, or laser ablation, used to treat smaller benign growths such as warts or tags. These procedures are typically quick and well-tolerated, with minimal postoperative discomfort.

Both approaches aim to treat the issue while preserving normal function and avoiding extensive surgery. They are often performed on an outpatient basis, allowing you to go home the same day.

Post-surgery care and recovery

Recovery following a perianal excision or lesion destruction is usually straightforward and significantly faster than major rectal surgeries. Most patients go home the same day and can return to normal activities within a few days to a week, depending on the procedure and individual healing. You may experience mild discomfort or soreness at the site, which can be managed with over-the-counter or prescribed pain relievers. There may be some minor bleeding or discharge initially, but this typically resolves quickly.

Proper wound care is essential – keeping the area clean and dry will reduce infection risk. Your provider will give you detailed aftercare instructions, including how to bathe and whether sitz baths are recommended. Bowel movements may be a bit uncomfortable at first, so a high-fibre diet and plenty of fluids can help ease this process.

Potential complications and risks

Although procedures for excision of rectal and anal lesions are considered minor to intermediate in complexity, there are still some risks to be aware of. These include localised infection, bleeding, delayed healing, or minor scarring. Rarely, if the lesion is deeper or if the margins are not clear, further treatment may be needed. However, when performed correctly, recurrence rates are low for benign or early-stage lesions.

Complications like urinary retention or temporary discomfort during bowel movements may occur, but are usually short-lived. Because these are focused, local procedures, major risks like deep infection, bowel injury, or permanent functional loss are extremely uncommon.

Oncological outcomes and quality of life

For benign or early-stage lesions, these procedures can achieve both complete removal and excellent long-term outcomes with minimal impact on quality of life. When lesions are cancerous, complete excision with clear margins can offer a curative approach without the need for more invasive surgery.

One of the main advantages of these treatments is preservation of normal bowel, bladder, and sexual function, which can be affected in more extensive surgeries. You’ll likely have follow-up appointments to monitor healing and, if the lesion was removed for histology, to review pathology results. If surveillance is needed, your provider may recommend periodic sigmoidoscopy or colonoscopy.

Overall, rectal and anal lesion excision procedures strike a balance between effective treatment and maintaining comfort, convenience, and quality of life, especially for patients with smaller, well-localised issues.