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Anal Sphincter Defect (anal + sphincter_defect)

Distribution by Scientific Domains
Medical Sciences100%

Selected Abstracts

B002 Sacral Nerve Modulation for Faecal Incontinence: Repaired Anal Sphincter Complex Versus Anal Sphincter Defect

COLORECTAL DISEASE, Issue 2006
J. Melenhorst
Objective, Sacral nerve modulation (SNM) for the treatment of faecal incontinence (FI) was originally performed with an intact anal sphincter. Two groups of patients were analysed to investigate whether SNM is as effective in patients with FI associated with an anal sphincter defect as in patients with FI after an anal repair (AR). Method, Group A was initially treated with an AR resulting in an anatomically intact anal sphincter. They were treated with SNM because of persisting or recurring FI. Group B consisted of patients with a defect in the sphincter primarily treated with SNM. The follow-up visits were scheduled at 1, 3, 6, and 12 months and annually thereafter. Results, Group A consisted of 20 patients. The mean number of incontinence episodes decreased significantly with SNM (P = 0.018). There was no significant difference in resting and squeeze pressures during SNM. Group B consisted of 20 women. The size of the defect in the anal sphincter varied between 17% and 33%. The mean number of incontinence episodes decreased significantly with SNM (P = 0.012). Again there was no significant change in the resting and squeeze pressures. Comparison between group A and B revealed no statistical difference. Conclusion, Faecal incontinence associated with an anal sphincter defect of <33% of the circumference can be treated primarily with SNM. [source]

Temporal endosonographic evaluation of anal sphincter integrity after primary repair for obstetric ruptures: a case for specific training of obstetricians

COLORECTAL DISEASE, Issue 7Online 2010
P. Pronk
Abstract Objective, To evaluate primary repaired obstetric lesions of the anal sphincter complex on anal endo-ultrasound within a few days and 8 weeks after primary repair and to investigate in this way the influence of suboptimal woundhealing on the final anatomical result. Furthermore to investigate the relation between faecal incontinence and sphincter defects. Design, A prospective cohort study. Setting, The obstetric clinic and coloproctology outpatient clinic of the Zaans Medical Centre in Zaandam, the Netherlands. Subjects, A cohort of 32 consecutive women with primary surgically repaired 3B, 3C or 4th degree anal sphincter defect after vaginal delivery. Main outcome measures, Appearance of the anal sphincter complex on anal endo-ultrasound within a few days week and 8 weeks after primary surgical repair, i.e. first and second ultrasound, respectively. Evaluation of anal continence, using the Vaizey incontinence score, at second ultrasound. Results, No major wound breakdown was seen and four women had superficial, skin related wound problems. Twenty-eight women (87.5%) had a repaired external anal sphincter on the first and the second ultrasound. Of four external anal sphincter defects on first ultrasound one defect was not present on second ultrasound. The internal sphincter showed a defect on first ultrasound in 11 women and this was still present in 10 on second ultrasound. A total of 11 women had a persisting anal sphincter defect (external, internal or in combination). Mean Vaizey scores were significantly higher in women with a persisting sphincter defect (EAS, IAS or in combination) than in women with no sphincter defects, 2.3 and 0.4 respectively (95% CI 0.1,3.6, P = 0.04). Conclusion, Anal endo-ultrasound may be used for early evaluation of surgical repair of anal sphincter lesions after vaginal delivery. Persisting defects in the anal sphincters, in this series not because of major wound breakdown, can be explained by inadequate surgical repair. [source]

Is a morphologically intact anal sphincter necessary for success with sacral nerve modulation in patients with faecal incontinence?

COLORECTAL DISEASE, Issue 3 2008
J. Melenhorst
Abstract Objective, Sacral nerve modulation (SNM) for the treatment of faecal incontinence was originally performed in patients with an intact anal sphincter or after repair of a sphincter defect. There is evidence that SNM can be performed in patients with faecal incontinence and an anal sphincter defect. Method, Two groups of patients were analysed retrospectively to determine whether SNM is as effective in patients with faecal incontinence associated with an anal sphincter defect as in those with a morphologically intact anal sphincter following anal repair (AR). Patients in group A had had an AR resulting in an intact anal sphincter ring. Group B included patients with a sphincter defect which was not primarily repaired. Both groups underwent SNM. All patients had undergone a test stimulation percutaneous nerve evaluation (PNE) followed by a subchronic test over 3 weeks. If the PNE was successful, a permanent SNM electrode was implanted. Follow-up visits for the successfully permanent implanted patients were scheduled at 1, 3, 6 and 12 months and annually thereafter. Results, Group A consisted of 20 (19 women) patients. Eighteen (90%) had a positive subchronic test stimulation. Twelve patients had a successful SNM implant during middle-term follow-up. Group B consisted of 20 women. The size of the defect in the anal sphincter varied between 17% and 33% of the anal circumference. Fourteen (70%) had a positive subchronic test stimulation. Twelve patients had a successful SNM implant during middle-term follow-up. In both groups, the mean number of incontinence episodes decreased significantly with SNM (test vs baseline: P = 0.0001, P = 0.0002). There was no significant difference in resting and squeeze pressures during SNM in group A, but in group B squeeze pressure had increased significantly at 24 months. Comparison of patient characteristics and outcome between groups A and B revealed no statistical differences. Conclusion, A morphologically intact anal sphincter is not a prerequisite for success in the treatment of faecal incontinence with SNM. An anal sphincter defect of <33% of the circumference can be effectively treated primarily with SNM without repair. [source]

B002 Sacral Nerve Modulation for Faecal Incontinence: Repaired Anal Sphincter Complex Versus Anal Sphincter Defect

COLORECTAL DISEASE, Issue 2006
J. Melenhorst
Objective, Sacral nerve modulation (SNM) for the treatment of faecal incontinence (FI) was originally performed with an intact anal sphincter. Two groups of patients were analysed to investigate whether SNM is as effective in patients with FI associated with an anal sphincter defect as in patients with FI after an anal repair (AR). Method, Group A was initially treated with an AR resulting in an anatomically intact anal sphincter. They were treated with SNM because of persisting or recurring FI. Group B consisted of patients with a defect in the sphincter primarily treated with SNM. The follow-up visits were scheduled at 1, 3, 6, and 12 months and annually thereafter. Results, Group A consisted of 20 patients. The mean number of incontinence episodes decreased significantly with SNM (P = 0.018). There was no significant difference in resting and squeeze pressures during SNM. Group B consisted of 20 women. The size of the defect in the anal sphincter varied between 17% and 33%. The mean number of incontinence episodes decreased significantly with SNM (P = 0.012). Again there was no significant change in the resting and squeeze pressures. Comparison between group A and B revealed no statistical difference. Conclusion, Faecal incontinence associated with an anal sphincter defect of <33% of the circumference can be treated primarily with SNM. [source]

Liverpool Ultrasound Pictorial Chart: the development of a new method of documenting anal sphincter injury diagnosed by endoanal ultrasound

BJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 6 2008
GE Fowler
Objective, To develop and validate a pictorial chart that documents ultrasound examination of the anal sphincter. Design, A new pictorial chart (Liverpool Ultrasound Pictorial Chart [LUPIC]) depicting the normal anatomy of the anal sphincter was developed. Methods, To validate LUPIC, two observers documented the findings of 296 endoanal scans. Reliability was assessed between observers using kappa agreement for presence and position of sphincter defects. To validate the use of LUPIC by different observers, a video of ten endoanal ultrasound scans was reviewed by our local expert (gold standard). Seven clinicians underwent test-retest analysis. Kappa agreement was calculated to assess intra-observer and gold standard versus observer agreement for the overall presence of sphincter defects and compared with the gold standard. Complete agreement for the position and level of sphincter defects was assessed for the five abnormal scans. Main outcome measures, Excellent agreement between the two observers was found for the presence (kappa 0.99), position and level of external anal sphincter defects documented using LUPIC. The intra-observer and gold standard versus observer kappa values of experienced clinicians (A,E) showed good agreement for the overall presence of sphincter defects. Complete agreement for the position and level of sphincter defects was found in 23 of 35 (66%) observations. Conclusions, LUPIC is designed and validated method of documenting anal sphincter injury diagnosed by endoanal ultrasound. Standardisation of endoanal ultrasound findings by using LUPIC may help correlate the degree of damage with patient symptoms. [source]

Temporal endosonographic evaluation of anal sphincter integrity after primary repair for obstetric ruptures: a case for specific training of obstetricians

COLORECTAL DISEASE, Issue 7Online 2010
P. Pronk
Abstract Objective, To evaluate primary repaired obstetric lesions of the anal sphincter complex on anal endo-ultrasound within a few days and 8 weeks after primary repair and to investigate in this way the influence of suboptimal woundhealing on the final anatomical result. Furthermore to investigate the relation between faecal incontinence and sphincter defects. Design, A prospective cohort study. Setting, The obstetric clinic and coloproctology outpatient clinic of the Zaans Medical Centre in Zaandam, the Netherlands. Subjects, A cohort of 32 consecutive women with primary surgically repaired 3B, 3C or 4th degree anal sphincter defect after vaginal delivery. Main outcome measures, Appearance of the anal sphincter complex on anal endo-ultrasound within a few days week and 8 weeks after primary surgical repair, i.e. first and second ultrasound, respectively. Evaluation of anal continence, using the Vaizey incontinence score, at second ultrasound. Results, No major wound breakdown was seen and four women had superficial, skin related wound problems. Twenty-eight women (87.5%) had a repaired external anal sphincter on the first and the second ultrasound. Of four external anal sphincter defects on first ultrasound one defect was not present on second ultrasound. The internal sphincter showed a defect on first ultrasound in 11 women and this was still present in 10 on second ultrasound. A total of 11 women had a persisting anal sphincter defect (external, internal or in combination). Mean Vaizey scores were significantly higher in women with a persisting sphincter defect (EAS, IAS or in combination) than in women with no sphincter defects, 2.3 and 0.4 respectively (95% CI 0.1,3.6, P = 0.04). Conclusion, Anal endo-ultrasound may be used for early evaluation of surgical repair of anal sphincter lesions after vaginal delivery. Persisting defects in the anal sphincters, in this series not because of major wound breakdown, can be explained by inadequate surgical repair. [source]