rectal instruments

DIVISION OF SPHINCTER FOR THERAPEUTIC PURPOSES


By • Дек 26th, 2010 • Category: Anus

In some diseases of the rectum we have to resort to partial division of the anal sphincter in the course of operation, so that its function could be temporarily ar­rested or decreased.

It is our practice to perform such sphincterotomy in operations for anorectal abscesses, anal fistulas and anal fissures by incising the sphincter from the side of the rectal lumen and dividing the subcutaneous and, frequ­ently, superficial portions of the external sphincter (Fig. 53). The deep portion of the sphincter is usually left in­tact. (See Fig. 6).

Two factors are of significance for the subsequent restoration of sphincteric function: the depth of the incision made and (2) the duration of rectal wound packing, the latter factor being more important.

Provided the ointment packing is discontinued 3 to 5 (not more!) days postoperatively, any sphincteric wound 1—2 cm deep will heal and sphincteric function restored. In males the incision may be carried along the anterior (scrotal) or posterior (coccygeal) perineal raphes to a depth of 1 cm or, in rare instances, 1.5 cm (Fig. 54). In females, such an incision (1 cm deep) may be made only along the posterior rectal wall, leaving the anterior wall intact (Fig. 55).

In parous women, the posterior wall may be dissected for a distance of 0.7—0.8 cm. In virgins and nulliparous women, the sphincter may be divided 1.0—1.2 cm deep. The lateral rectal walls may be incised to a depth of 0.7 cm in females and 1 cm in males. The incision depth is determined by the width of the scalpel blade which should be just 1 cm wide (Fig. 56,1 and 2). After the sphincter has been incised the blades of the rectal speculum are approximated as far as they will go, so that the wound depth can be readily ascertained from the scalpel width. The packing of the rectum and the sphinc-teric wound should be discontinued 3 days in females and 5 days in males, postoperatively. It must be borne in mind that a more prolonged packing may lead to sphincteric weakness.

Partial division of the sphincter from the rectal lumen

Fig. 53 Partial division of the sphincter from the rectal lumen.

Fig. 54 Direction and permissible depth of sphincter di­vision in the male.

pig. 55 Direction and permissible depth of sphincter di-> vision in the female.

Estimating the depth of sphincter incision witt the scalpel blade I cm wide

Fig. 56 Estimating the depth of sphincter incision witt the scalpel blade I cm wide:

1. Sphincter is dissected into the rectal lumen enlar ged with rectal speculum.

2. Having approximated the speculum blades, th< surgeon ascertains the wound depth.



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