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Techniques for Laparoscopic Low Anterior Resection, Ultra Low Anterior Resection, and Inter Sphincteric Resection (ISR)
Published in Haribhakti Sanjiv, Laparoscopic Colorectal Surgery, 2020
S Rajapandian, R Parthasarathy, Raghavendra Gupta, Sunil Kumar Nayak, C Palanivelu
Anal manometry should be done before ileostomy closure. Patients are made to hold increasing volumes of saline infused rectally in the weeks preceding the anticipated ileostomy closure. Ability of the patient to comfortably hold 200 mL of saline and ambulate without any leak indicates adequate sphincter function. It is also essential to rule out any distal obstruction prior to ileostomy reversal.
Antegrade access as an adjunct to bowel management: Appendicostomy and neoappendicostomy
Published in Alejandra Vilanova-Sánchez, Marc A. Levitt, Pediatric Colorectal and Pelvic Reconstructive Surgery, 2020
Rebecca M. Rentea, Devin R. Halleran, Alejandra Vilanova-Sánchez
In patients with functional constipation, Hirschsprung disease should be ruled out with a rectal biopsy that shows the presence of ganglia with normal nerves. An AMAN (if over age 1) can also rule out Hirschsprung disease. The absence of a history of failure to thrive or episodes of enterocolitis make this diagnosis very unlikely. Additionally, a contrast enema, anal manometry, and colonic manometry can be very useful in the work-up of patients with functional constipation prior to any surgical intervention.
Anal Manometry
Published in Han C. Kuijpers, Colorectal Physiology: Fecal Incontinence, 2019
Elisa H. Birnbaum, James W. Fleshman
Anal manometry supplies objective information about internal and external anal sphincter function. Anal manometry is useful in the evaluation of incontinence, constipation, and location of sphincteric injuries. In addition, anal manometry is used for preoperative assessment of sphincter function prior to procedures that may affect continence. Low squeeze pressure and shortened sphincter length may identify the location of a sphincteric injury. Because scarring in the region of prior injury may give falsely elevated pressures, anal manometry should always be correlated with clinical findings.
Botulinum toxin injection is an effective alternative for the treatment of chronic anal fissure
Published in Acta Chirurgica Belgica, 2023
Of the six patients with relapsing disease, two preferred to be admitted to another center and four received secondary treatments. Anal manometry was performed on those four patients and revealed increased resting pressure in all of them. Of those four patients, three underwent repeat BTA injection and one underwent LIS. Of the three patients who received repeat BTA injection, two had a complete and one had a partial response (this patient refused further treatment and was satisfied with the treatment as it was). The patient who underwent LIS achieved a complete response. Of these four patents treated for relapsing disease, one patient who received repeat BTA injection had minor incontinence, and no continence problem was seen in the others. The median follow-up time was 24 (18–42) months. Figure 4 summarizes the results of patients with refractory and relapsing diseases.
Assessment of anal sphincter distensibility following the STARR procedure: a pilot study
Published in Acta Chirurgica Belgica, 2020
Charlotte Desprez, Chloé Melchior, Guillaume Gourcerol, Jean-Jacques Tuech, Estelle Houivet, Anne-Marie Leroi, Valérie Bridoux
Although some patients develop de novo anal incontinence after the STARR procedure, previous studies have shown that anal pressures at rest and during voluntary contraction remain unchanged post-surgery [2]. Anal manometry is the standard method for assessing anal sphincter function. However, it may be inappropriate for evaluating the consequences of dilatation on the biomechanical properties of the anal sphincter as it appears that measuring the radial force by resistance to distension, i.e. distensibility, rather than closing pressure alone should be a prime determinant of the viscoelastic properties of the anal canal [3]. Only a few studies have evaluated anal sphincter function using the newly available EndoFLIP® system. We recently found that the distensibility index at rest and during voluntary contraction is significantly higher in patients with faecal incontinence than in healthy subjects [3]. Distensibility indexes thus appear to be more appropriate than anal pressures for discriminating between patients with faecal incontinence and healthy subjects, suggesting that the distensibility index is more specific than anal pressure in identifying an anal sphincter weakness [3]. It is likely that these reassuring results with respect to the potential consequences on the anal sphincter of dilatation during the STARR procedure may also apply to other surgeries requiring similar anal dilatation such as trans-anal endoscopic microsurgery (TEM), which is the gold standard for local excision of rectal lesions [7].
Late effects in patients with sacrococcygeal teratoma: A single center series
Published in Pediatric Hematology and Oncology, 2018
Salih Güler, Metin Demirkaya, Emin Balkan, İrfan Kırıştıoğlu, Nizamettin Kılıç, Betül Sevinir
In this study, while chronic constipation was present in one-fourth of the patients, fecal incontinence was present in one patient. Compared to the present study, constipation was reported at higher rates by Shalaby et al.,[14] with 39% and by Rintala et al.,[17] with 35%; whereas, this rate was reported 13.3% by Bittmann et al.,[19] and 17% by Derikx et al[20]. Kremer et al.[6] found the constipation rate as 21% as similar to the present study. The rate of patients using laxatives due to constipation was 14.8%. Dysfunction in anal manometry had a lower rate. This was a parallel situation to the previous studies[2,19]. However, these results should not suggest that risk of neurogenic rectum is absent or rare in patients having SCT resection. This is because it is difficult to evaluate rectal dysfunction with clinical and rectal manometry. Significant rectal dysfunction should be present clinically for both children and families in order to report abnormal bowel habits. In addition, studies have reported that interpretation of rectomanometry is difficult especially due to the compliance difficulties of young children. For this reason, only the normality in the history or in the rectomanometry does not completely exclude the rectal dysfunction.