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In fecal incontinence (FI), surgery may be carried out if conservative measures alone are not sufficient to control symptoms. There are many surgical options described for FI, and they can be considered in 4 general groups. [1] Restoration and improvement of residual sphincter function ; sphincteroplasty (sphincter repair)
Lateral internal sphincterotomy is the preferred method of surgery for persons with chronic anal fissures, and is generally used when medical therapy has failed. [1] It is associated with a lower rate of side effects than older techniques such as posterior internal sphincterotomy and anoplasty, [3] and has also been shown to be superior to topical glyceryl trinitrate (GTN 0.2% ointment) in ...
Anal manometry is sometimes used to investigate changes in the anal canal before and after the procedure. Usually mean anal resting pressure and mean anal squeeze pressure are the parameters used. [3] Improvements in these measurements are often, but not always reported up to 3–12 months after the procedure.
Anal sphincterotomy is a surgical procedure that involves treating mucosal fissures from the anal canal/sphincter. [ 1 ] [ 2 ] The word is formed from sphincter + otomy (to cut, to separate). [ 3 ]
The internal anal sphincter, IAS, or sphincter ani internus is a ring of smooth muscle that surrounds about 2.5–4.0 cm of the anal canal. It is about 5 mm thick, and is formed by an aggregation of the smooth (involuntary) circular muscle fibers of the rectum.
The surgery is planned in such a way that it takes place 2–3 days after the cessation of menstrual flow, such that there is ample time for the surgical wound to heal until the next menses. Succinylsulfathiazole is the recommended intestinal antiseptic given two days before the surgery since it keeps the stool soft in the post-operative period.
Defects of the external anal sphincter are associated with urge incontinence. [22] The external anal sphincter is supplied by the pudendal nerve. Damage to the nerve supply of the external anal sphincter on one side may not result in severe symptoms because there is substantial overlap in innervation by the nerves on the other side. [2]
The main concern with surgery is the development of anal incontinence. Anal incontinence can include the inability to control gas, mild fecal soiling, or loss of solid stool. Some degree of incontinence can occur in up to 45 percent of patients in the immediate surgical recovery period. However, incontinence is rarely permanent and is usually mild.