[Surgical treatment concept in traumatic sphincter lesions]

The surgical problems of traumatic sphincter lesions are reported comparing early and late repair. In 11 acute injuries the surgical concept consisted generally of proximal fecal deviation, distal washout, reconstruction of the muscular defects and presacral drainage. In soft tissue injuries (grade I, n = 2) complete healing without functional deficiencies was obtained inspite of renouncing fecal diversion. In isolated ruptures of the rectum or the sphincter (grade II, n = 3) and in complete disruption of both components (grade III, n = 4) after healing and closure of the temporary colostomy continence was estimated subjectively as being sufficient. Patients' overall-appraisal was not correlated to the preoperative degree of destruction not the postoperative measurement of continence. Only when devascularisation of the anorectum with severe bleeding had occurred (grade IV, n = 2) proctectomy was necessitated resulting in one death. In none of 5 patients operated on elsewhere there was a chance of secondary sphincteric reconstruction. During operation or endosonographically and electromyographically the sphincter musculature could not be detected. Obviously renouncing of anatomical reconstruction leads not only to retraction but also to secondary degeneration of the sphincter muscles.