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Operative therapy for anal incontinence.

D J Schoetz

    The Surgical Clinics of North America
    |February 1, 1985
    PubMed
    Summary

    Surgical treatment for fecal incontinence involves understanding anatomy and physiology. Various techniques, from sphincter repair to slings and rarely colostomy, address different causes of incontinence.

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    Area of Science:

    • Gastroenterology and Colorectal Surgery
    • Pelvic Floor Disorders
    • Surgical Anatomy

    Background:

    • Fecal incontinence necessitates a thorough grasp of anatomical and physiological underpinnings.
    • Understanding pathophysiological mechanisms is crucial for effective operative therapy.
    • Diverse etiologies, including sphincter injury, obstetric trauma, and descending perineum syndrome, contribute to fecal incontinence.

    Purpose of the Study:

    • To outline the principles and techniques of operative therapy for fecal incontinence.
    • To provide guidance on selecting appropriate surgical interventions based on the underlying cause.
    • To review management strategies for various types of fecal incontinence.

    Main Methods:

    • Direct sphincter repair for external sphincter injuries.
    • Plastic surgical reconstruction for extensive obstetric injuries involving the perineal body.
    • Postanal plication of the puborectalis sling for descending perineum syndrome and associated incontinence or rectal prolapse.
    • Silastic sling placement for complex neurologic disorders or failed puborectalis repairs.
    • Consideration of diverting colostomy as a last resort.

    Main Results:

    • Direct sphincter repair is effective for many external sphincter injuries.
    • Obstetric injuries require comprehensive perineal reconstruction.
    • Postanal plication addresses descending perineum syndrome effectively.
    • Silastic slings offer an alternative for complex cases.
    • Diverting colostomy is reserved for refractory cases after all other options fail.

    Conclusions:

    • Operative management of fecal incontinence is tailored to specific etiologies.
    • A stepwise approach, from direct repair to reconstructive surgery and slings, is recommended.
    • Diverting colostomy should be a rare intervention, employed only after exhaustive evaluation and failure of all other surgical options.

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