OVERLAPPING REPAIR IN THE PATIENTS WITH ANAL SPHINCTER

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  Notes
 
 
Slide 1 : OVERLAPPING REPAIR IN THE PATIENTS WITH ANAL SPHINCTER INJURY Gulhane Mil. Medical Academy General Surgical Clinic, Div. of GI Tract Surgery & Gynecol and Obstet. Clinic Ankara, Turkiye (Turkey) Dr. Sezai Demirbas (Assoc. Prof) Dr. Vedat Atay Dr. Ilker Sucullu Dr. A Ilker Filiz
Slide 2 : socially disabling disorder Prevalence is about 2-15% in adult people In the elderly women 17% It is the major cause vaginal delivery when using forceps 0,5-3% of women w/Obstet. Tra. during vaginal delivery Previous perianal surgery and pelvic trauma. It significantly deteriorates patient’s life. 2 MSPFD-Cairo, 2008 Tetzschner, Br J Obstet Gynaecol 1996, 103 Sultan AH, BMJ 1994, 308
Slide 3 : …with sphincter repair Could re-establish continence and improve life quality Operative technique was first described by Parks in 1971 Slade modified the procedure in 1977 However recent reports have stated that the outcome of OSR in the patients with obstetric injury seldom perfect in long-term [*]. *Halverson AL, Dis Colon Rectum 45: 2002,345-48 3 MSPFD-Cairo, 2008
Slide 4 : The aim …to show the outcome of OSR(*) is required in any injury on the anal canal to improve the anal function patient’s life quality and evaluate superior in the patients with non-obstetric trauma than those with obstetrical one (*) OSR: Overlapping sphincter repair 4 MSPFD-Cairo, 2008
Slide 5 : How to examination Physical exam Digital rectal exam Rectoscopy and/or rectosigmoidoscopy Measuring of anal canal function by manometer FISI was determined Anal canal mapping by EAUS Overlap sphincter repair Antibiotic (periop), Pain control No ostomy needed Follow up by using QoL questionnaire SF36-FI 5 MSPFD-Cairo, 2008
Slide 6 : Operative technique FI results from Obstetrics located ant. Try finding the tips of the sphincter 6 MSPFD-Cairo, 2008 Preservation scar influences the outcome Moscovich, colorectal Dis, 2002
Slide 7 : Dissecting to expose the tips 7 MSPFD-Cairo, 2008 Bulky sphincters , mobilization If scar excision done and direct apposition lead to a disruption of 40% (*) (*) Blaisdell, Surg Gynecol Obstet 1940
Slide 8 : …overlapping (OSR) 8 MSPFD-Cairo, 2008 Placed around the anal canal Suturing w/2-0 prolene
Slide 9 : …repair done. Repair done Prolene suture, because of longer t ½ Vicryl for perineal skin closure 9 MSPFD-Cairo, 2008
Slide 10 : At the end & 2 wk.s after repair 10 MSPFD-Cairo, 2008 Muscle over scar (hyperechoic/hypoechoic)
Slide 11 : 44 pt.s underwent OSR 11 MSPFD-Cairo, 2008
Slide 12 : FISI(*) scores in the pt.s with failure (*); Rockwood, Halverson, the lower FISI score the higher QoL of the patients ; DCR, 1999; Coloproctology 2003 12 MSPFD-Cairo, 2008
Slide 13 : outcomes of anal manometer 13 MSPFD-Cairo, 2008
Slide 14 : Main goal; better anal function with anal canal widen then life quality of pts should be increased less than 10% of patients was fully continent to solid and liquid (1) after 77 mo. follow up 71 % of pt.s improved (2) increase in mean MSP & mean AS Length (3,4) 80 mo. follow, 80% success(n=64pts.) (7) pts underwent OR over 50 y; not clear (5) inappropriate to choise one type of repair in favor of another (6, 8, pelvic pain, dyspareunia, anal incont, QoL) Discussion Tjandra , DCR, 2003, 46:937 Sitzler, DCR, 1996, 39:1356 Malouf, Lancet 2000, 355:260 Ha, DCR, 2001, 44:655 14 MSPFD-Cairo, 2008 Oliveira, Br J Surg 1996, 83:502 Fitzpatrick M, Am J Obstet Gynecol 2000, 183 Duthie, J Am. Coll Surg; 2007 Cochrane Database system rev., 2006
Slide 15 : Life quality 15 MSPFD-Cairo, 2008

 


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