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SPHINCTERIC FUNCTION PRIOR TO AND AFTER OPERATIVE TREATMENT IN PATIENTS WITH FISTULA


By • Дек 26th, 2010 • Category: Rectum

The function of the anal sphincter was studied using a tonometric sphincterometer and a dynamometric device fitted with a strain gauge (Fig. 89). The data obtained have enabled us to ascertain the strength of the sphinc­ter prior to and after operation, as well as to obtain average values for sphincteric strength in normal indi­viduals. In males the maximum strength of the anal sphincter is 96 mm Hg (740 g), and that of the sphincter tone, 24 mm Hg (530 g). In females these values are 25 per cent lower.

In the case of a superficial rectal fistula laid open in­to the rectal fistula laid open into the rectal lumen (see Figs 74 and 79), the strength and tone of the sphincter return to normal within an average of 30 days. In the case of a intrasphincteric fistula, laid open into the rec­tal lumen with of the wound bottom (see Fig. 75), the sphincter strength drops by 3 to 4 mm (70 to 90 g) but, forty five days postoperatively, sphincteric function equals that prior to the operation.

In high-level fistula, following the operative procedure as described earlier (see Figs 77, 80 and 81), the sphinc­ter strength drops by 3 to 5 mm Hg (70—110 g) by the 22 nd postoperative day to return to the preoperative value by the 90th day, on an average. (Occasionally it even exceeds the preoperative value by 2 mm Hg). (See Fig. 90,1 and 2). If the ligature technique is used (see Figs 83), by the 90th postoperative day the sphincter strength is 4—7 mm Hg (120—150 g) less than preopera-tively and fails to increase thereafter (Fig. 90,3 and 4). Starting 30 to 40 days after the operation for high-level fistula we use exercise therapy with the patient, either lying or sitting, contracting and drawing in the anus up­wards to a slow count of one, two, and three, followed by muscle relaxation to the count of four, five, six, seven, and eight. These exercises should be continued for from 5 to 7 minutes three times daily until sphincteric func­tion returns to normal or improves, In rare instances, we resort to electrostimulation of the sphincter with the exponential form of current in the rhythm of sphincteric exercises

Sphincterograms in complicated fistula-in-ano

Fig. 89 Sphincterometer fitted with a tension gauge.

Fig. 90 Sphincterograms in complicated fistula-in-ano:

1. Prior to operation.

2. Three months after operation for high-level compli­cated fistula.

3. Sphincterograms in complicated rectal fistula prior to ligation.

4. Sphincterogram 3 months following ligation.



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