The subject of surgical treatment for anal incontinence is rapidly advancing, evidenced by the fact that more and more general surgeons are performing these procedures. The condition arises in women often after childbirth. Until now anal incontinence was considered incurable; the possibility of cure means that more operations will be performed and more surgeons will need this book.

Klappentext

New surgical techniques for the treatment of anal incontinence have given the increasing number of afflicted patients hope for a cure. Colorectal surgeons and more and more general surgeons are performing operations, yet until now they have not had a text that they can use as a reference work. The guidance and instruction that surgeons need are now available in this atlas. It describes every operation in technical detail, and the two-color illustrations clearly show the essential points of each procedure. The authors discuss thoroughly the indications for surgical treatment, its application to the individual patient, and post-operative care. The comprehensive scope of this book makes it a rich source of information for surgeons working outside highly specialized centers. For specialists, it is the only practical reference available on the subject.

Inhalt

1 Essential Anatomy of Anal Continence.- General Introduction.- Structural Anatomy.- Development.- Anal Muscles.- Blood Supply.- Venous Drainage.- Nerve Supply.- Surgical Anatomy.- The Rectum.- The Anus.- 2 Physiology of Anal Continence.- General Introduction.- Patho-physiology of Continence.- Proximal Alimentary Tract.- Colon.- Ano-rectum.- Applied Physiology.- 3 Abdominal Techniques.- General Introduction.- Abdominal Rectopexy with Prosthetic Implant (Syn. Wells Technique).- Indications and Selection of Patients.- Preparation.- Operative Technique.- Post-operative Management.- Abdominal Rectopexy with Prosthetic Sling (Syn. Ripstein Technique).- Indications and Selection of Patients.- Preparation.- Operative Technique.- Post-operative Management.- Abdominal Rectopexy plus Colon Resection (Syn. Goldberg Technique).- Indications and Selection of Patients.- Preparation.- Operative Technique.- Post-operative Management.- Results.- Laparoscopic Rectopexy for Rectal Prolapse.- Operative Technique.- Post-operative Management.- 4 Anterior Perineal Techniques.- General Introduction.- Anterior Plication of Puborectalis and Anal Sphincter (Syn. Anterior Buttress Technique, Anterior Levatorplasty).- Indications and Selection of Patients.- Operative Technique.- Post-operative Management.- Anterior Sling Procedure (Syn. Notaras Technique).- Indications and Selection of Patients.- Preparation.- Operative Technique.- Post-operative Management.- Results.- 5 Posterior Perineal Techniques.- General Introduction.- Post-anal Intersphincteric Repair (Syn. Parks Technique. Posterior Levatorplasty).- Indications and Selection of Patients.- Preparation.- Operative Technique.- Post-operative Management.- Results.- Post-rectal Buttress Repair (Syn. Wyatt Technique).- Indications and Selection of Patients.- Preparation.- Operative Technique.- Post-operative Management.- Results.- 6 Circum-anal Techniques.- General Introduction.- Circum-anal Wire (or Nylon) Encirclement (Syn. Thiersch Procedure).- Indications and Selection of Patients.- Preparation.- Operative Technique.- Post-operative Management.- Circum-anal Cicatrical Fixation (Syn. Saraffof Technique).- Indications and Selection of Patients.- Operative Technique.- Post-operative Management.- Results.- Gracilis Muscle Sling Procedure (Syn. Pickrell-von Rapport Technique).- Indications and Selection of Patients.- Preparation.- Operative Technique.- Post-operative Management.- Results.- Stimulated Graciloplasty by B.J. Mander and N.S. Williams.- General Introduction.- Indications and Selection of Patients.- Preparation.- Operative Technique.- Stage 1.- Stage 2.- Post-operative Care Following Stage 2.- Results.- 7 Per-anal Techniques.- General Introduction.- Anterior (Rectal) Mucosectomy.- Indications and Selection of Patients.- Preparation.- Operative Technique.- Post-operative Management.- Rectal Wall Plication (Syn. Delorme Technique).- Indications and Selection of Patients.- Preparation.- Operative Technique.- Post-operative Management.- Rectosigmoidectomy (Syn. Altemeier Technique).- Indications and Selection of Patients.- Preparation.- Operative Technique.- Post-operative Management.- Results.- 8 Technique of Anal Sphincter Repair (Syn. Overlap Technique).- Indications and Selection of Patients.- Preparation.- Operative Technique.- Post-operative Management.- Results.- 9 Techniques for Congenital Anal Deformity Encountered in Later Life.- General Introduction.- Identification and Assessment of Abnormality.- General Principles Underlying the Operations.- Selection and Preparation of Patients for Surgery.- Covered Anus Deformity with Associated Perineal Fistula ("False Anus").- Anterior Ectopic Deformity.- No Definite Anal or Puborectalis Muscle.- Ectopic Opening Adjacent to an Anal Orifice ("Shot-gun Deformity").- Cloacal-type Deformity.- Post-operative Management.- Summary.- 10 Techniques for Repair of Traumatic Injury of the Anal Sphincters.- General introduction.- Indications and Selection of Patients.- Preparation.- Acute Primary Repair of Traumatised Anal Sphincter and Pelvic Floor.- Operative Technique.- Post-operative Management.- Trans-vaginal Injury to the Anus and Rectum.- Immediate Repair of Acute Trans-vaginal Injury.- Operative Technique.- Post-operative Management.- Delayed Repair of Chronic Unhealed Recto-vaginal Septal Defect.- Preparation.- Operative Technique.- Post-operative Management.- 11 Techniques for Repair of Recto-vaginal Fistula.- I: Low Recto-vaginal Fistula Repairs.- General Introduction.- Indications and Selection of Patients.- Preparation.- Excision and Repair of Low Juxtasphincteric Fistula.- Operative Technique.- Post-operative Management.- Per-vaginal Direct Repair of Low Supra-sphincteric Fistula.- Operative Technique.- Post-operative Management.- Per-anal Closure of Low Supra-sphincteric Fistula by Advancement Flap.- Operative Technique.- Post-operative Management.- II: High Recto-vaginal Fistula Repairs.- General Introduction.- Indications and Selection of Patients.- Preparation.- Direct Closure Using Interposed Omental Graft.- Operative Technique.- Post-operative Management.- Extended Resection with Colo-anal Anastomosis.- Operative Technique.- Post-operative Management.- 12 Salvage Procedures.- General Introduction.- Silastic Sling Encirclement.- Inflatable Anal Prosthesis.- Faecal Diversion (by a Stoma).- 13 General Supportive Measures.- General Introduction.- Enhancement of Sphincter Responses to Sensory Stimuli by Biofeedback.- Improvement of Anal Sphincter Tone and Reactivity.- Enhancement of the Efficiency of Rectal Emptying.- Alteration of the Consistency of the Stools.- Reduction of Colonic Motor Activity.- Promotion of Increased Patient Awareness and Co-operation.