PubMed Health⌕ Search
Home/Archive/PubMed

PubMed · 3729277

Anal sphincter function and sphincter preserving surgery.

M R Keighley
View original source ↗Export metadata ↓

Abstract

This article reviews the methods of assessing anal sphincter function and the place of sphincter-saving surgery in patients seen in the Gatrointestinal Unit of the Birmingham General Hospital between 1976 and 1984. (The main parameters for assessing sphincter function are maximinal and pressure at rest, maximum squeeze pressure, length of the high pressure zone, electromyography and parameters of rectal sensation.) Poor functional results were observed for patients having restorative surgery for rectal cancer when there is evidence of extrarectal tumour infiltration. It has now become our policy to avoid primary resection and anastomosis for fixed rectal cancer and for cancer involving the side walls of the pelvis. We would also question the value of low sphincter-saving surgery in patients with manometric evidence of a weak anal sphincter. Assessment of rectal capacity has been of predictive value in selecting patients suitable for ileorectal anastomosis in Crohn's disease. Sphincter preserving surgery in ulcerative colitis by ileorectal anastomosis or ileoanal anastomosis with pouch is unpredictable and continence is often imperfect. Repair of a rectal prolapse alone by a posterior rectopexy restores continence to 70% of patients but if incontinence persists post anal repair is beneficial in approximately 50% of cases. Incontinence which does not improve with medical therapy can often be restored by surgical treatment. Post anal repair restores continence to approximately 70% of cases and sphincter reconstruction to 80%.

Explore related subjects

Anal CanalColitis, UlcerativeColonCrohn DiseaseFecal IncontinenceFemaleHumansMaleMethodsNeoplasm Recurrence, LocalRectal NeoplasmsRectal ProlapseSex FactorsJournal Article

Keep this discovery

Explore connections, maps & timelines

BibTeXRIS

M R Keighley. 1986. Anal sphincter function and sphincter preserving surgery.. https://pubmed.ncbi.nlm.nih.gov/3729277/

Cite the original work for its findings. Save a collection to share your selection of sources.

KEEP EXPLORING

Related citations

PubMed2007

Rectoanal junction colonization of feedlot cattle by Escherichia coli O157:H7 and its association with supershedders and excretion dynamics.

Feedlot cattle were observed for fecal excretion of and rectoanal junction (RAJ) colonization with Escherichia coli O157:H7 to identify potential "supershedders." RAJ colonization and fecal excretion prevalences were correlated, and E. coli O157:H7 prevalences and counts were significantly greater for RAJ samples. Based on a comparison of RAJ and fecal ratios of E. coli O157:H7/E. coli counts, the RAJ appears to be preferentially colonized by the O157:H7 serotype. Five supershedders were identified based on persistent colonization with high concentrations of E. coli O157:H7. Cattle copenned with supershedders had significantly greater mean pen E. coli O157:H7 RAJ and fecal prevalences than noncopenned cattle. Cumulative fecal E. coli O157:H7 excretion was also significantly higher for pens housing a supershedder. E. coli O157:H7/E. coli count ratios were higher for supershedders than for other cattle, indicating greater proportional colonization. Pulsed-field gel electrophoresis analysis demonstrated that isolates from supershedders and copenned cattle were highly related. Cattle that remained negative for E. coli O157:H7 throughout sampling were five times more likely to have been in a pen that did not house a supershedder. The data from this study support an association between levels of fecal excretion of E. coli O157:H7 and RAJ colonization in pens of feedlot cattle and suggest that the presence of supershedders influences group-level excretion parameters. An improved understanding of individual and population transmission dynamics of E. coli O157:H7 can be used to develop preslaughter- and slaughter-level interventions that reduce contamination of the food chain.

Anal Canal↗
PubMed2007

Postpartum evaluation of the anal sphincter by transperineal three-dimensional ultrasound in primiparous women after vaginal delivery and following surgical repair of third-degree tears by the overlapping technique.

OBJECTIVE: Intrapartum damage to the anal sphincter is an important factor in fecal incontinence. Recognized lacerations occur in 0.36-8.4% of vaginal deliveries, and occult sphincter damage in up to 35% of primiparous women. We examined the role of three-dimensional transperineal ultrasound (3DTUS) in the evaluation of the anal sphincter in primiparous women after vaginal delivery and after surgical repair of third-degree intrapartum tears by the overlapping technique. METHODS: During 2004-2005 139 primiparous women without clinically recognized third- to fourth-degree anal sphincter tears were prospectively studied 24-72 h postpartum (Group 1) and 13 primiparous women were examined 48 h to 4 months following surgical repair of third-degree tears with the overlapping technique (Group 2). A 3D 5-9-MHz transvaginal probe was placed in the area of the fourchette and perineal body in transverse and sagittal planes and 2-4 volumes were stored. The parameters studied were: examination duration; continuity of the internal and external sphincters; occult sphincter damage; internal sphincter and external sphincter width-measured 1.5 cm from the distal margin of the anus-at the '12, 3, 6 and 9 o'clock positions'; length of the posterior internal sphincter. RESULTS: Scanning was possible in all women and the stored volumes were adequate in 127/139 (91.4%) cases. Mean examination time was 3.5 min. In Group 1, occult sphincter defect was suspected in 10/127 women (7.9%). These patients were excluded from measurement calculations, leaving 117 cases for analysis. The internal sphincter was consistently visualized in all the remaining patients (n = 117), while the external sphincter was fully visualized in 99/117 women (84.6%), and partially visualized in the remainder. Mean internal sphincter thickness was 2.60, 2.55, 2.60 and 2.72 mm at the 12, 3, 6 and 9 o'clock positions, respectively, and mean internal sphincter length was 3.34 cm. Mean external sphincter thickness was 4.15, 4.20, 4.21 and 4.20 mm at the 12, 3, 6 and 9 o'clock measurement points. In Group 2, 3DTUS confirmed anatomic abnormalities in all the women in the area surrounding the 12 o'clock position. Evaluation of sphincter tears and their position and length was possible using the longitudinal view. Thinning of the internal sphincter in the area of damage and thickening on the opposite side, the 'half moon sign', sphincter discontinuity, thickening of the external sphincter in the area of repair and abnormality of mucous folds, seemed to be common signs of third-degree intrapartum sphincter tears, even after repair. CONCLUSIONS: 3DTUS is an accessible and promising method for postpartum sphincter evaluation, that is apparently well tolerated by patients. Reference data for sphincter anatomy representative of findings at transperineal ultrasound in primiparous women in the postpartum period have been established.

Anal Canal↗