Anal sphincter repair

Anal sphincter repair for surgical treatment of anal incontinence. Anal incontinence is divided into 3 categories: 1 complete incontinence: the anus loses control of dry stool, loose stools and gas; 2 incomplete incontinence: anus can control dryness, but can not control loose stools and gas; 3 sensory incontinence: unconsciously There are a small amount of loose stools and gas spills that contaminate the underwear. There are many reasons for anal incontinence, such as high anal fistula, rectal vaginal septum injury, perianal abscess after incision, advanced rectal prolapse, rectal cancer resection, circumcision and congenital Anal diseases, etc., but the main cause of injury during surgery. Anal incontinence is caused by mechanical disorders such as anal rectal prolapse or long-term prolapse of internal hemorrhoids. After the primary disease is cured, incontinence can heal itself, and only a few require surgical treatment. Incontinence caused by other causes, such as with appropriate surgical methods, most patients can be completely cured or improved. The choice of surgical procedure depends on the extent and type of sphincter damage. Treatment of diseases: anal trauma Indication 1. It is only suitable for anal sphincter injury caused by trauma or surgical cutting. The defect range does not exceed 1/3 of the anal canal sphincter circumference, and the muscle fiber can still contract. 2. If the wound is infected, it should be repaired within 6 to 12 months after infection control to avoid muscle atrophy. Contraindications The time for treatment is too late, the sphincter has shrunk into fibrous tissue, and those who are difficult to find and suture during surgery are not suitable for surgery. Preoperative preparation 1. Enter the semi-liquid 3~5d before the operation, and clear the fluid 1~2d before operation. 2. 3 days before the laxative, take 25% magnesium sulfate 30ml or castor oil 30ml every night. 3. 3 days before enema, saline enema 1 time per night, clean enema before surgery. 4. Oral antibiotics The following options can be selected: 1 neomycin 1g, erythromycin 0.5g, 1d 8th, 14h, 18h and 22 hours before surgery; 2 kanamycin 1g , metronidazole 0.4g, 3 days before surgery, 3 times a day. 5. Other drugs vitamin K 4 ~ 8mg, 4 times a day. 6. The perianal skin is shaved. Surgical procedure 1. Take the scar tissue near the sphincter as the center, away from the anus, and make a U-shaped incision. 2. After cutting the skin, peel off the subcutaneous tissue, and open the flap together with the scar tissue to the anus side, reveal the sphincter, find the broken end and remove the scar tissue between the two ends of the sphincter, and retain the connective tissue on the broken end. It is not easy to break when suturing muscle fibers. 3. Use two tissue clamps to clamp the end of the internal and external sphincters, cross-test the sphincter's mobility and tightness. After appropriate, insert a 1.5 cm diameter anoscope into the anus and try to pull the sphincter. The end-to-end suture was separately sutured with a silk thread. After the broken end was pulled, a number of needles were intermittently sutured in the outer layer, and after careful hemostasis, the anoscope was taken out and the flap was sutured. 4. If the sphincter defect is too wide, but does not exceed 1/3 of the circumference, the suturing can not be done at one time, and staged surgery can be used. According to the upper method, the broken end is removed, the scar tissue is removed, and the broken end is pulled. The distance between the two ends is as close as possible, and the broken end is temporarily fixed on the adjacent soft tissue by the 32-gauge stainless steel wire. After 3 months, if the anal incontinence has not improved, surgery can be performed and the broken end can be sutured. complication Wound infection can lead to non-healing or splitting of muscle fibers, which is often the main cause of surgical failure.