rectal instruments


By • Дек 21st, 2010 • Category: Rectum

In sphincteric insufficiency of second or third degree, which is mainly due to a loss of tone or scarring of the posterior sphincteric wall, the author’s method of choice is the suture of the posterior half of rectal circumference and anal sphincter with Lembert-type stitches. This pro­cedure is identical to the concluding stage of Lockhart-Mummery operation for rectal prolapse (see Figs 117,5 and 117,6).

The patient is placed in the knee-elbow position with soft pillows beneath his knees. Under local infiltration anesthesia according to Vishnevsky a semilunar incision is made along the posterior semicircumference of the anus (Fig. 135,1) 2.5—3 cm external to the anal orifice, a skin flap is dissected off and turned downwards with Allis forceps. The posterior semicircumference of the external sphincter is then exposed by means of a scalpel, and the anococcygeal ligament of the levatores is dissected longitudinally. The both levator ani muscles are next moved apart, and the posterior semicir­cumference of the rectum is exposed as far as the coccy-geal apex. Now 4 or 5 silk or capron Lembert sutures are placed to include the posterior semicircumference of the rectum (1—2 sutures) and sphincter (2—3 sutures), as shown in Fig. 135,2. The sutures are tied tightly with three knots each. The retracted margins of the levatores are closed with 2 catgut sutures (Fig. 135,3). Each flap is then put in place and sutured with catgut leaving two rubber drainage tubes (Fig. 135,4). Opium tincture is given for 7 days.

Operation for suture of the posterior semicir­cumference of the external sphincter

Fig. 135 Operation for suture of the posterior semicir­cumference of the external sphincter. (Rygick’s method):

1. The patient is in the knee-elbow position. The line of incision along the posterior anal semicircumference has been marked out.

2. The principal stage of the operation — placing Lembert sutures on the posterior sphincteric semicircum­ference under the guidance of the surgeon’s left index finger introduced into the rectal lumen.

3. The levatores are sutured over the posterior rectal surface with two rubber

4. Appearance of the skin wound drainage tubes inserted.

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