rectal instruments

OPERATIONS FOR INSUFFICIENCY OF SPHINCTERIC FUNCTION


By • Дек 21st, 2010 • Category: Anus

Clinically,a distinction is made between the first (in­continence of gas), second (incontinence of liquid fe-ces), and third (incontinence of hard feces) degrees of impairment ci sphincteric function. In operations for sphincteric weakness, the author makes a preternatural anus into the sigmoid rather rarely, since the above des­cribed (p. 41) procedure for postoperative management of patients with long-continued confinement of bowels (up to 14 days) often permits to dispense with an artificial

Suture of the sphincter according to Lockhart-Mummery

Under local or combined inhalation anesthesia and in the lithotomy position an incision is made along the posterior anal circumference (Fig. 133,1), and first a skin flap and then a part (I to 2 cm long) of the posterior segment of anal canal mucosa are dissected off upwards (Fig. 133,2) This important phase of operation should be performed carefully lest the mucosa be injured The dis­sected mucosa is then elevated with a blunt Farabef re­tractor, and 3 or 4 wide I.embert sutures of capron or silk are placed on the subcutaneous and superficial por­tions of the sphincter (Fig 133,3),

When the sutures are tied, the posterior half of the distended sphincter crimps and shortens appreciably. The surgeon can determine the degree of narrowing of the anal ring by introducing the little finger into the anus. The mucocutaneous flap is then slightly shortened and sutured to the edges of the skin wound with catgut (Fig. 133,4). Thin rubber drainage tubes are inserted in both angles of the wound.

Opium tincture is given for 8—9 days. The patient’s bowels are first moved by an enema (600—800 ml)

Operation for suture of the sphincter according to Lockhart-Mummery

Fig. 133 Operation for suture of the sphincter according to Lockhart-Mummery:

1. Incision along the posterior anal semicircumference.

2. Dissection of skin and exposure of superficial and subcutaneous portions of the external sphincter.

3. Application of Lembert sutures on the subcutaneous and superficial portions of the sphincter.

4. The skin flap, after being trimmed, is put in place and sutured with calgut. Narrow drainage tubes have been introduced through the wound angles.



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