Frequency of Operative Trauma to Anal Sphincters

Abstract

Sphincter trauma after anorectal surgery is usually asymptomatic. Frequency of trauma cannot be established with the clinical examination only. The frequency of operative sphincter defects and their correlation with disorders of continence was evaluated with the endoanal ultrasound. This study includes 123 subjects who had undergone anorectal surgery in the past and were examined with endoanal ultrasound for various indications such as continence disorders, recurrent fistula, idiopathic perineal pain, or simple postoperative follow-up. No subjects had isolated external anal sphincter defects. Nineteen of 123 patients (15%) had minor or major continence disorders, 55 patients (45%) had no sphincter defects, 42 (34%) had only internal anal sphincter (IAS) defects, and 26 (21%) had simultaneously external and internal anal sphincter (EAS) defects. The incidence of IAS and EAS trauma after Milligan-Morgan hemorrhoidectomy was 1/18 (5.5%) and 0/18 respectively; after fistula repair, 24/42 (57%) and 12/42 (29%); and after anal dilatation, 13/17 (76%) and 4/17 (24%). Sixteen of 26 patients (62%) with EAS trauma and 51/68 patients (75%) with IAS trauma did not report any disorders of continence. In patients with two or more operations, the frequency of IAS trauma was 74%, 30% for EAS trauma, and 26% for continence disorders.

The Role of 3-Dimensional Anorectal Ultrasonography in the Assessment of Anterior Transsphincteric Fistula

“…Because of the high rate of continence disorders after fistulotomy, 22,28,29 methods of sphincter integrity preservation, such as fibrin glue and anal fistula plugs, should be considered in female patients presenting with anterior transsphincteric fistula with Ͼ50.0% EAS involvement. Three-dimensional anorectal ultrasonography was shown to be useful in the preoperative assessment of anterior transsphincteric fistulas by quantifying the length of muscle to be transected, thereby contributing to the choice of a safe treatment approach and to the reduction of the rate of postoperative continence disorders.…”

Still a Case of “No Pain, No Gain”? An Updated and Critical Review of the Pathogenesis, Diagnosis, and Management Options for Hemorrhoids in 2020

“…Causes include changes in mucosal sensitivity and anal sphincter pressures following surgery, changes in the symmetry and closure of the anal canal following removal of haemorrhoidal tissue, and occult damage to the sphincter complex during haemorrhoidectomy. One study identified that internal sphincter damage was detectable endosonographically in over 5% of patients following open haemorrhoidectomy [67].…”

Acquired fecal incontinence in community-dwelling adults

“…15 Studies suggest that stretch injury from anal retractor use during surgery decreases anal resting pressures. 16,17 IAS and EAS may also be injured after anorectal surgery, although only roughly one-third of these patients reported FI 18 ; neurogenic damage and rectal ischemia may occur. 19…”