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Incontinence after lateral internal sphincterotomy: anatomic and functional evaluation
J García-Aguilar1, C Belmonte Montes, J J Perez
1Department of Surgery, University of Minnesota, Minneapolis, USA.
Diseases of the Colon and Rectum
|April 29, 1998
Summary
Anal incontinence after lateral internal sphincterotomy is linked to longer sphincterotomies and a thinner external sphincter. These anatomical changes impact continence following the procedure.
Area of Science:
- Colorectal surgery
- Gastroenterology
- Anorectal physiology
Background:
- Lateral internal sphincterotomy is a common surgical treatment for anal fissures.
- Anal incontinence is a potential complication following this procedure.
- Understanding the anatomical and functional changes is crucial for patient outcomes.
Purpose of the Study:
- To evaluate the anatomical and functional consequences of lateral internal sphincterotomy.
- To compare patients with anal incontinence post-sphincterotomy to continent controls.
Main Methods:
- Inclusion of 13 incontinent patients and 13 continent controls who underwent lateral internal sphincterotomy.
- Utilized clinical evaluation, anorectal manometry, pudendal nerve terminal motor latency testing, and endoanal ultrasonography.
- Comparative analysis of sphincterotomy length, pressures, sensation, nerve latency, and sphincter thickness.
Main Results:
- Longer sphincterotomies were observed in incontinent patients (75% vs. 57%).
- External sphincter thickness was reduced in incontinent patients at the sphincterotomy site and posteriorly.
- Internal sphincter defects were wider in incontinent patients, though not statistically significant.
Conclusions:
- The length of the lateral internal sphincterotomy directly correlates with the development of anal incontinence.
- A thinner external sphincter in incontinent patients may be due to preoperative abnormalities or the surgical procedure itself.