No abstract

Anal sphincter function was assessed by digital examination and anal canal manometry in 66 patients and controls. Digital scores were allotted by using visual analogue scales for basal and squeeze sphincter function and were compared with the corresponding pressures. There were good correlations between digital basal score and maximum basal pressure (Spearman rank correlation coefficient rs = 0.56, P less than 0.001), and digital squeeze score and maximum squeeze pressure (rs = 0.72, P less than 0.001). There were wide ranges of sphincter function on digital and manometric assessment with considerable overlap between patient groups. Digital scores detected differences in sphincter function between patient groups as accurately as manometry. The sensitivities and specificities of digital scores and anal canal manometry in segregating continent and incontinent patients were similar. It was concluded that digital estimation was equally as good as assessment of anal sphincter function as anal canal manometry.

A new operation is described in which a neorectum and neoanal sphincter mechanism have been constructed to restore gastrointestinal continuity and continence in a patient who had previously undergone proctocolectomy and a permanent ileostomy. The neorectum was constructed by forming a triplicated pouch from the distal ileum. The neoanal sphincter was fashioned from a transposed gracilis muscle and was activated electrically by an implanted stimulator. A period of chronic low frequency stimulation altered the muscle characteristics and enabled the neosphincter to contract continually without fatigue. Complete continence was achieved by the neosphincter gripping a Silastic plug inserted within the efferent spout of the pouch. The patient was able to void completely when the stimulator was switched off and the plug removed.

An oral dose of indoramin (20 mg) administered twice daily reduced anal resting pressure by 30% compared with pretreatment levels but was ineffective in healing chronic anal fissures.