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Audit of anal-sphincter repair
Department of General Surgery, University Hospital Maastricht, Maastricht, The Netherlands.
Linköping University, Department of Biomedicine and Surgery, Surgery. Linköping University, Faculty of Health Sciences.
Linköping University, Department of Biomedicine and Surgery, Surgery. Linköping University, Faculty of Health Sciences.
Department of General Surgery, University Hospital Maastricht, Maastricht, The Netherlands.
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2001 (English)In: Colorectal Disease, ISSN 1462-8910, E-ISSN 1463-1318, Vol. 3, no 1, 17-22 p.Article in journal (Refereed) Published
Abstract [en]

Objective

Structural damage of the anterior part of the anal sphincter is a major cause of faecal incontinence. Sphincter repair is the standard surgical treatment. This study was designed to analyse the results of anal sphincter repair, to identify possible predictors of outcome and to investigate the presence of bowel symptoms other than leakage at follow up.

Patients and methods

Fifty-five women (median age 39 years, range 24–73 years) who underwent anal sphincter repair between 1986 and 1997 at the University Hospital of Linköping answered a postal questionnaire. Current bowel function, degree of continence and the patients’ functional result as worse, unchanged, some improvement, good or excellent were assessed. Good or excellent function was regarded as a successful result, the rest as failure. Age, duration of symptoms, type of surgery, morbidity and length of follow up were analysed in relation to outcome. Results of pre- and post-operative anal manometry, endoanal ultrasound, anal sphincter electromyography and pudendal nerve function were also analysed.

Results

After a median (range) follow-up period of 40 months (5–137) months, 31 (56%) patients rated the result as either excellent (n=10) or good (n=21). Twenty-one (38%) patients rated the result as some improvement (n=14), unchanged (n=6) or worse (n=1). In three (5%) patients a colostomy was fashioned because of failure. Patients >50 years at surgery (n=18) had a worse outcome (P=0.001). Successful outcome was correlated to increased squeeze pressures post-operatively. The presence of post-operative urgency (P=0.01) and loose stools (P=0.02) was more common in patients with poor outcome. Eight patients became continent to formed and liquid stool.

Place, publisher, year, edition, pages
2001. Vol. 3, no 1, 17-22 p.
Keyword [en]
Anal sphincter repair, Audit, Faecal incontinence
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-25046DOI: 10.1111/j.1463-1318.2001.00205.xLocal ID: 9474OAI: oai:DiVA.org:liu-25046DiVA: diva2:245372
Available from: 2009-10-07 Created: 2009-10-07 Last updated: 2017-12-13Bibliographically approved
In thesis
1. Anatomical and physiological aspects of anorectal dysfunction
Open this publication in new window or tab >>Anatomical and physiological aspects of anorectal dysfunction
2002 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Objective: To analyse the results of anal-sphincter repair; to examine the feasibility of motor latency measurements of the anal sphincter after magnetic sacral stimulation in healthy subjects, patients with a spinal cord injury and patients with faecal incontinence, using a new recording technique; to study, in the same 3 groups, the effects ofphasic magnetic sacral root stimulation on the anal sphincter and rectum; to describe normal, undisturbed anatomy of the anal canal and perianal structures in both men and nulliparous women using high-resolution phased array magnetic resonance imaging; to study pelvic floor movements in healthy volunteers of both sexes using a new instrument.

Methods: Latencies were recorded with an intraanal, bipolar sponge electrode and an intrarectal ground electrode. Rectal volume changes were measured with a barostat. Highresolution magnetic resonance images were obtained without an endoanal coil. Pelvic floor movements where measured with the subject seated, using a magnet attached to a rectal balloon.

Results: After a median period of 40 months, 31/55 female patients rated the result of analsphincter repair as excellent or good. Age>50 years, and post-operative urgency and loose stools were associated with poor outcome. Eight patients became fully continent for stool. 17% of the latency measurements failed. There were no significant differences between leftand right-sided stimulation. Faecal incontinence patients had prolonged pudendal nerve terminal motor latencies and prolonged latencies after left-sided magnetic stimulation. Phasic magnetic stimulation increased anal pressure in 100% of the 14 healthy subjects, 86% of the 14 spinal cord injury patients and 73% of the 18 faecal incontinence patients. A decrease in rectal volume was provoked in respectively 72 %, 79 % and 50 %. In all 33 volunteers, anal and perianal structures could be well defined by magnetic resonance imaging. The mid-anal canal was significantly longer than its anterior and posterior part. The female anterior sphincter was shorter than the male and occupied 30 % of the anal canal length. The female perineal body was thicker and easier to define than the male. The median pelvic floor lift and descent measured in 28 healthy volunteers, were 2 cm and 1.8 cm respectively. Day-to-day and inter-observer reproducibility were good. 20/28 subjects were able to expel the rectal balloon.

Conclusions: Anal-sphincter repair does not restore complete continence but leads to a satisfactory result in more than half of the patients. Additional bowel symptoms are common at follow-up. Latency measurements after magnetic stimulation are minimally invasive and have a low failure rate. They may be used to test the integrity of the distal motor pathway in patients who may benefit from continuous sacral root stimulation. Magnetic sacral root stimulation produces an increase in anal and rectal pressure and a decrease in rectal volume. Phased array magnetic resonance imaging is non-invasive and allows an accurate description of the normal anatomy of the anal canal and perianal structures. The new developed instrument measures cranial and caudal movement of the pelvic floor with minimal discomfort and good reproducibility.

Place, publisher, year, edition, pages
Linköping: Linköpings universitet, 2002. 96 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 721
Keyword
Anal canal, Anal-sphincter repair, Audit, Magnetic resonance imaging, Magnetic stimulation, Latency, Pelvic floor, Sacral roots
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-25693 (URN)10069 (Local ID)91-7373-163-3 (ISBN)10069 (Archive number)10069 (OAI)
Public defence
2002-03-22, Berzeliussalen, Universitetssjukhuset, Linköping, 09:00 (Swedish)
Opponent
Available from: 2009-10-08 Created: 2009-10-08 Last updated: 2012-10-17Bibliographically approved

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Hallböök, OlofNyström, Per-OlofSjödahl, Rune

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