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Anal sphincter repair

Nadia Rahman, Latha Vinayakarao, Sangeeta Pathak, Dawn Minden, Louise Melson, Ella Vitue, A Pradhan
INTRODUCTION AND HYPOTHESIS: The objective was to assess the feedback from a quality improvement training programme to reduce obstetric anal sphincter injuries (OASIS). METHODS: Training sessions were organised that included evidence-based information on OASIS risk factors and training on models to measure perineal body length (PBL), perform episiotomies with standard and 60° fixed angle scissors (EPISCISSORS-60®), and measure post-delivery episiotomy suture angles with protractor transparencies...
October 25, 2016: International Urogynecology Journal
Ka Lai Shek, Ixora Kamisan Atan, Hans Peter Dietz
OBJECTIVES: The aim of this study was to correlate clinical findings of anal sphincter defects and function with a sonographic diagnosis of significant sphincter defects. METHODS: This is an observational cross-sectional study on women seen 6 to 10 weeks after primary repair of obstetric anal sphincter injuries (OASIs). All patients underwent a standardized interview including the St Mark incontinence score, a digital rectal examination, and 3-/4-dimensional transperineal ultrasound imaging...
September 26, 2016: Female Pelvic Medicine & Reconstructive Surgery
Dimos Sioutis, Ranee Thakar, Abdul H Sultan
OBJECTIVES: To identify the accuracy of clinically diagnosed OASIS using 3D endoanal ultrasound and compare symptoms and anal manometry measurements between those whose anal sphincters were adequately repaired to those who had persistent anal sphincter defects. METHODS: The endoanal scan images of women who sustained OASIS and attended the perineal clinic over a 10 year period (2003 - 2013) were re-analysed from data entered prospectively of women with clinically diagnosed and repaired OASIS...
September 19, 2016: Ultrasound in Obstetrics & Gynecology
Kristiina Kyrklund, Mikko P Pakarinen, Risto J Rintala
AIMS: To compare anorectal manometry (AM) in patients with different types of anorectal malformations (ARMs) in relation to functional outcomes. METHODS: A single-institution, cross-sectional study. After ethical approval, all patients ≥7years old treated for anterior anus (AA), perineal fistula (PF), vestibular fistula (VF), or rectourethral fistula (RUF) from 1983 onwards were invited to answer the Rintala bowel function score (BFS) questionnaire and to attend anorectal manometry (AM)...
September 2, 2016: Journal of Pediatric Surgery
Cristina Ros Cerro, Eva Martínez Franco, Giulio Aniello Santoro, Maria José Palau, Pawel Wieczorek, Montserrat Espuña-Pons
INTRODUCTION AND HYPOTHESIS: The aim was to analyze the correlation between residual anal sphincter (AS) defects and pelvic floor muscle (PFM) strength on anal incontinence (AI) in patients with a history of obstetric AS injuries (OASIS). METHODS: From September 2012 to February 2015, an observational study was conducted on a cohort of females who underwent repair of OASIS intrapartum. The degree of OASIS was scored intrapartum according to Sultan's classification...
September 9, 2016: International Urogynecology Journal
Victoria A Lane, Clare Skerritt, Richard J Wood, Carlos Reck, Geri D Hewitt, Kate A McCracken, Venkata R Jayanthi, Daniel DaJusta, Christina Ching, Katherine J Deans, Peter C Minneci, Marc A Levitt
INTRODUCTION: A significant number of internationally adopted children have congenital birth defects. As a specialist center for colorectal diagnoses, we evaluate such children with an anorectal malformation (ARM) and have found that a significant number need a reoperation. Knowledge of the common complications following ARM surgery has led us to develop treatment algorithms for patients with unknown past medical and surgical history, a situation typically encountered in the adopted population...
November 2016: Journal of Pediatric Surgery
Audrius Dulskas, Narimantas E Samalavicius
PURPOSE: For several decades, the low anterior resection (LAR) with total mesorectal excision (TME) has been the gold standard for treating patients with rectal cancer. Up to 90% of patients undergoing sphincter-preserving surgery will have changes in bowel habits, so-called 'anterior resection syndrome.' This study examined patients' continence after a LAR for the treatment of rectal cancer. METHODS: This prospective study was performed between September 2014 and August 2015 at the National Cancer Institute and included 30 patients who underwent anorectal manometry preoperatively and at 3 and 4 months after a LAR, but 10 were excluded from further evaluation for various reasons...
June 2016: Annals of Coloproctology
R S van Onkelen, M P Gosselink, M van Meurs, M J Melief, W R Schouten, J D Laman
BACKGROUND: Sphincter-preserving procedures for the treatment of transsphincteric fistulas fail in at least one out of every three patients. It has been suggested that failure is due to ongoing disease in the remaining fistula tract. Cytokines play an important role in inflammation. At present, biologicals targeting cytokines are available. Therefore, detection and identification of cytokines in anal fistulas might have implications for future treatment modalities. The objective of the present study was to assess local production of a selected panel of cytokines in anal fistulas, including pro-inflammatory interleukin (IL)-1β and tumor necrosis factor α (TNF-α)...
September 2016: Techniques in Coloproctology
Sameh Hany Emile, Mohamed Youssef, Hossam Elfeki, Waleed Thabet, Hesham Elgendy, Waleed Omar, Wael Khafagy, Mohamed Farid
BACKGROUND: The physiologic assessment of anal sphincters in cases of posttraumatic fecal incontinence is a fundamental step in planning operative treatment. In this study, we evaluate the correlation between size of anal sphincter defect, anal pressures, and clinical symptoms in patients with posttraumatic fecal incontinence. We also investigate the impact of patients' age, sex, and type of trauma on this correlation. METHODS: Records of 70 patients fitting the study's eligibility criteria were collected retrospectively from the archives of Mansoura University Hospitals' colorectal surgery unit...
July 5, 2016: Surgery
Zhao Ding, Xiangui Liu, Xianghai Ren, Qiulei Zhang, Tingtao Zhang, Qun Qian, Weicheng Liu, Congqing Jiang
According to recent studies, mesenchymal stromal cells (MSCs) transplanted via local or tail vein injection can improve healing after anal sphincter injury (ASI) in animal models. However, the transplanted MSCs do not generate skeletal muscle that completely resembles the natural anal sphincter structure. In the present study, we investigated whether bone marrow (BM)-derived MSCs could be induced by Galectin-1 (Gal-1) to differentiate into skeletal muscle and whether the recellularization of an acellular dermal matrix (ADM) with skeletal muscle-differentiated MSCs represents a promising approach to restore ASI in a rat model...
May 2016: Discovery Medicine
(no author information available yet)
Lacerations are common after vaginal birth. Trauma can occur on the cervix, vagina, and vulva, including the labial, periclitoral, and periurethral regions, and the perineum. Most of these lacerations do not result in adverse functional outcomes. Severe perineal lacerations, extending into or through the anal sphincter complex, although less frequent, are more commonly associated with increased risk of pelvic floor injury, fecal and urinary incontinence, pain, and sexual dysfunction with symptoms that may persist or be present many years after giving birth...
July 2016: Obstetrics and Gynecology
(no author information available yet)
Lacerations are common after vaginal birth. Trauma can occur on the cervix, vagina, and vulva, including the labial, periclitoral, and periurethral regions, and the perineum. Most of these lacerations do not result in adverse functional outcomes. Severe perineal lacerations, extending into or through the anal sphincter complex, although less frequent, are more commonly associated with increased risk of pelvic floor injury, fecal and urinary incontinence, pain, and sexual dysfunction with symptoms that may persist or be present many years after giving birth...
July 2016: Obstetrics and Gynecology
Benedetta Mazzanti, Bruno Lorenzi, Annalisa Borghini, Margherita Boieri, Lara Ballerini, Riccardo Saccardi, Elisabetta Weber, Federica Pessina
BACKGROUND: Anal incontinence is a disabling condition that adversely affects the quality of life of a large number of patients, mainly with anal sphincter lesions. In a previous experimental work, in-vitro expanded bone marrow (BM)-derived mesenchymal stem cells (MSC) were demonstrated to enhance sphincter healing after injury and primary repair in a rat preclinical model. In the present article we investigated whether unexpanded BM mononuclear cells (MNC) may also be effective. METHODS: Thirty-two rats, divided into groups, underwent sphincterotomy and repair (SR) with primary suture of anal sphincters plus intrasphincteric injection of saline (CTR), or of in-vitro expanded MSC, or of minimally manipulated MNC; moreover, the fourth group underwent sham operation...
2016: Stem Cell Research & Therapy
Søren Gräs, Cæcilie Krogsgaard Tolstrup, Gunnar Lose
INTRODUCTION AND HYPOTHESIS: Anal incontinence is a common disorder but current treatment modalities are not ideal and the development of new treatments is needed. The aim of this review was to identify the existing knowledge of regenerative medicine strategies in the form of cellular therapies or bioengineering as a treatment for anal incontinence caused by anal sphincter defects. METHODS: PubMed was searched for preclinical and clinical studies in English published from January 2005 to January 2016...
June 16, 2016: International Urogynecology Journal
H H Johannessen, A Wibe, A Stordahl, L Sandvik, S Mørkved
OBJECTIVE: To evaluate the effect of pelvic floor muscle exercises (PFME) for postpartum anal incontinence (AI). DESIGN: A parallel two-armed randomised controlled trial stratified on obstetrical anal sphincter injury with primary sphincter repair and hospital affinity. SETTING: Ano-rectal specialist out-patient clinics at two hospitals in Norway. POPULATION: One hundred and nine postpartum women with AI at baseline...
June 7, 2016: BJOG: An International Journal of Obstetrics and Gynaecology
Saleh M Eftaiha, George Melich, Ajit Pai, Slawomir J Marecik, Leela M Prasad, John J Park
INTRODUCTION: Bowel dysfunction (fecal incontinence and constipation) presents in over 50% of patients after treatment of congenital anal malformations. Sacral nerve stimulation (SNS) for the treatment of fecal incontinence improves function in the majority of patients. We present a case report of the treatment of bowel dysfunction with sacral nerve stimulation in a patient with a history of an imperforate anus. PRESENTATION OF CASE: A twenty year-old female with a history of imperforate anus at birth, repaired during infancy with anorectoplasty, presented with fecal incontinence and constipation...
2016: International Journal of Surgery Case Reports
Andreia Albuquerque, Eduardo Pereira
Transperineal ultrasound is an inexpensive, safe and painless technique that dynamically and non-invasively evaluates the anorectal area. It has multiple indications, mainly in urology, gynaecology, surgery and gastroenterology, with increased use in the last decade. It is performed with conventional probes, positioned directly above the anus, and may capture images of the anal canal, rectum, puborectalis muscle (posterior compartment), vagina, uterus, (central compartment), urethra and urinary bladder (anterior compartment)...
April 28, 2016: World Journal of Radiology
Judith T W Goh, Stephanie B M Tan, Harriet Natukunda, Isaac Singasi, Hannah G Krause
INTRODUCTION: In many rural low-income countries, perineal tears at time of vaginal birth are not repaired at time of delivery. The aims of this study are to describe the surgical technique for management of the unrepaired 4th degree tear, performed without flaps, and short-term follow up on anal incontinence symptoms using a validated questionnaire. METHODS: Women presenting to fistula camps in western Uganda with unrepaired 4th degree tears were interviewed using the Cleveland Clinic Continence Score...
April 30, 2016: International Urogynecology Journal
Jaan Kirss, Tarja Pinta, Camilla Böckelman, Mikael Victorzon
INTRODUCTION: The success of the primary repair of obstetric anal sphincter injury (OASI) is paramount in maintaining adequate fecal continence after childbirth. The factors determining the success or failure of primary repair are unclear. The aim of this study is to investigate modifiable factors determining the success or failure of the primary sphincter repair after OASI. MATERIAL AND METHODS: Sixty women with OASI were investigated by endoanal ultrasound or magnetic resonance imaging, and with the Wexner incontinence questionnaire...
September 2016: Acta Obstetricia et Gynecologica Scandinavica
C Ros, E Martínez-Franco, M M Wozniak, J Cassado, G A Santoro, N Elías, M López, M Palacio, A P Wieczorek, M Espuña-Pons
OBJECTIVES: Endoanal ultrasound (EAUS) is the gold standard investigation of anal sphincter integrity. Aim of this study was to compare the sensitivity and specificity of 3D-EAUS with 2D and 3D transperineal US (TPUS), and 3D endovaginal US (EVUS) in detecting residual defects after primary repair of obstetric anal sphincter injuries (OASIS). METHODS: The external (EAS) and internal anal sphincters (IAS) were evaluated in women with OASIS by four ultrasound modalities...
March 22, 2016: Ultrasound in Obstetrics & Gynecology
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