Anal Sphincter Injury

Browning, G. G. P.; Motson, R. W.

doi:10.1097/00000658-198403000-00017

Cited by 73 publications

(14 citation statements)

References 15 publications

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“…Short-term success rates of up to 80% have been reported in repair of obstetric injuries, but in the long term it is now apparent that these results are not sustained [9][10][11][12]. A poor outcome after sphincter repair may be related to such factors as ageing, acute (e.g.…”

Section: Discussionmentioning

confidence: 99%

“…A poor outcome after sphincter repair may be related to such factors as ageing, acute (e.g. sepsis) or chronic separation of the repair, underlying pudendal neuropathy or pelvic floor dysfunction [9,13,14]. The encouraging results of surgery directed at occult defecographic findings, such as RI or rectocele [15,25,29,30], suggest that these abnormalities may underpin faecal incontinence in some patients, and therefore might explain the suboptimal results of sphincter repair.…”

Section: Discussionmentioning

confidence: 99%

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Rectal intussusception and unexplained faecal incontinence: findings of a proctographic study

et al. 2008

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Rectal intussusception and unexplained faecal incontinence: findings of a proctographic study

et al. 2008

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“…Fecal incontinence may be caused by anorectal surgery (for fistulas, hemorrhoids, abscesses or tumors) and traumatic accidents, but primarily by injury due to vaginal delivery [1]. The damage, which is frequently both mechanical and neurological [2]in origin, mainly occurs due to muscle rupture during vaginal delivery.…”

Section: Introductionmentioning

confidence: 99%

Long-Term Results of Anterior Anal Sphincter Repair for Fecal Incontinence due to Obstetric Injury / with Invited Commentaries

Rothbarth¹,

Bemelman²,

Meijerink³

et al. 2000

Dig Surg

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Aims: This study is to report short- and long-term results of anterior sphincter repair for fecal incontinence due to obstetric injury and factors predicting an unsuccessful outcome. Methods: Thirty-nine consecutive patients, mean age 51 years (range 29–74), who underwent anterior sphincter repair for fecal incontinence due to obstetric injury were investigated. Duration of symptoms ranged from 9 months to 34 years. All patients underwent an anterior overlapping sphincter muscle reconstruction and in most cases a puborectal muscle plasty. Results: Three months after surgery 77% of the patients had regained continence (Parks score of 1 or 2), at 9 months 67% were continent and after 12 months or more (mean, range 12–114) only 62%. Patients with prolonged pudendal latency (>2.2 ms) did significantly worse than patients without it (p < 0.05). Patients who had had lateral episiotomy during labor had significantly better outcome than those without it (p < 0.05). Conclusion: The outcome of anterior sphincter repair deteriorates with time after surgery. Assessment should be done at least 1 year after surgery to evaluate the final results of anterior sphincter repair. Prolonged pudendal latency predicts a poor outcome of anterior sphincter repair, and a prior lateral episiotomy is possibly a good prognostic factor.

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“…This led to the use of an alternative method of direct repair utilizing an overlapping technique, providing good functional results. [7][8][9][10] In our cohort of 29 patients, all underwent overlapping anal sphincteroplasty with only 3 patients (10.34%) still having anal incontinence . We also encountered anal stenosis in 8 patients on follow-up which was managed with anal dilatation using metallic dilators.…”

Section: Resultsmentioning

confidence: 97%

Managing traumatic anal sphincter injuries without the use of endo-anal ultrasound: an experience with 29 patients presenting to the surgery department at a tertiary care centre in North India

et al. 2016

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INTRODUCTIONEndosonography is the method of choice for preoperative imaging of External Anal Sphincter (EAS), having an established role in identifying sphincter defects 1 Sphincter defect mapping helps the surgeon by confirming the exact site and nature of the defect. The physiological function of the sphincter mechanism is assessed by anorectal manometry and pudendal nerve terminal motor latency test. 2 We present here in our paper results of sphincter repair done in traumatic external sphincter defects with clinical examinations as the only pre-operative tool used to assess and map the sphincter defect as well as to assess the probability of success of the repair. ABSTRACTBackground: Endosonography is the method of choice for pre-operative imaging of External Anal Sphincter (EAS), having established its role in identifying sphincter defects. We present here results of sphincter repair done in traumatic external sphincter defects with clinical examinations as the only pre-operative tool, to evaluate and map the sphincter defect as well as to assess the probability of success of the repair. Methods: The data has been collected from an ongoing prospective study over a period of 5 years (2008 -2013) in patients with fecal incontinence secondary to traumatic anal sphincter injuries detected during initial presentation in acute setting. Clinical assessment was used in isolation to diagnose EAS defect. Contraction of the sphincter on inspection and per rectal examination was done to assess the location of the defect. All patients underwent the usual overlapping sphincter repair with covering stoma under general anesthesia. The location and size of the defect found during surgery was recorded and compared with the clinical findings. Results: Cohort of 29 patients over a period of 5 years (2008)(2009)(2010)(2011)(2012)(2013) with traumatic sphincter injury were included in this study who underwent overlapping sphincter repair. (21/29) patients were male patients, road traffic accidents was the most common etiology (23/29) followed by sphincter complex injury related to obstetric and gynaecological procedure (5/29). Majority of patients were managed with fecal diversion (27/29). (24/27) patients had their stoma's reversed and were fully continent. 8 patients developed anal stenosis managed with repeated self-anal dilatation on follow-up. Conclusions: Pre-operative clinical assessment with intra-operative assessment of the site of sphincter injury is a good clinical tool in detecting the size and site of the defect for surgical repair of injured anal sphincter without using endoanal ultrasonography.

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Anal Sphincter Injury

Cited by 73 publications

References 15 publications

Rectal intussusception and unexplained faecal incontinence: findings of a proctographic study

Rectal intussusception and unexplained faecal incontinence: findings of a proctographic study

Long-Term Results of Anterior Anal Sphincter Repair for Fecal Incontinence due to Obstetric Injury / with Invited Commentaries

Managing traumatic anal sphincter injuries without the use of endo-anal ultrasound: an experience with 29 patients presenting to the surgery department at a tertiary care centre in North India

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