Anal sphincter function and sphincter preserving surgery.

Area of Science:

• Gastroenterology
• Colorectal Surgery
• Surgical Outcomes

Background:

• Anal sphincter function assessment is crucial for surgical decision-making.
• Sphincter-saving procedures are increasingly utilized for various anorectal conditions.
• Evaluating functional outcomes guides surgical technique selection.

Purpose of the Study:

• To review methods for assessing anal sphincter function.
• To evaluate the efficacy of sphincter-saving surgery in specific patient groups.
• To determine the impact of surgical interventions on continence.

Main Methods:

• Review of patient data from 1976-1984 at Birmingham General Hospital.
• Assessment of anal sphincter function using manometry, electromyography, and rectal sensation tests.
• Analysis of surgical outcomes for rectal cancer, Crohn's disease, ulcerative colitis, and rectal prolapse.

Main Results:

• Poor functional results observed in rectal cancer patients with extrarectal infiltration.
• Ileorectal anastomosis for Crohn's disease showed predictive value based on rectal capacity.
• Sphincter preservation in ulcerative colitis yielded unpredictable continence.
• Posterior rectopexy restored continence in 70% of rectal prolapse cases; post-anal repair benefited 50% of persistent incontinence cases.
• Post-anal repair and sphincter reconstruction achieved 70% and 80% continence rates, respectively.

Conclusions:

• Avoid primary resection and anastomosis for fixed rectal cancer or pelvic sidewall involvement.
• Question the value of low sphincter-saving surgery in patients with manometrically weak anal sphincters.
• Surgical repair, including post-anal repair and sphincter reconstruction, can significantly restore continence in cases of fecal incontinence.