Surgical Treatment of Anal Incontinence

1 Essential Anatomy of Anal Continence.- General Introduction.- Structural Anatomy.- Development.- Anal Muscles.- Blood Supply.- Venous Drainage.- Nerve Supply.- Surgical Anatomy.- The Rectum.- The Anus.- 2 Physiology of Anal Continence.- General Introduction.- Patho-physiology of Continence.- Proximal Alimentary Tract.- Colon.- Ano-rectum.- Applied Physiology.- 3 Abdominal Techniques.- General Introduction.- Abdominal Rectopexy with Prosthetic Implant (Syn. Wells Technique).- Indications and Selection of Patients.- Preparation.- Operative Technique.- Post-operative Management.- Abdominal Rectopexy with Prosthetic Sling (Syn. Ripstein Technique).- Indications and Selection of Patients.- Preparation.- Operative Technique.- Post-operative Management.- Abdominal Rectopexy plus Colon Resection (Syn. Goldberg Technique).- Indications and Selection of Patients.- Preparation.- Operative Technique.- Post-operative Management.- Results.- Laparoscopic Rectopexy for Rectal Prolapse.- Operative Technique.- Post-operative Management.- 4 Anterior Perineal Techniques.- General Introduction.- Anterior Plication of Puborectalis and Anal Sphincter (Syn. Anterior Buttress Technique, Anterior Levatorplasty).- Indications and Selection of Patients.- Operative Technique.- Post-operative Management.- Anterior Sling Procedure (Syn. Notaras Technique).- Indications and Selection of Patients.- Preparation.- Operative Technique.- Post-operative Management.- Results.- 5 Posterior Perineal Techniques.- General Introduction.- Post-anal Intersphincteric Repair (Syn. Parks Technique. Posterior Levatorplasty).- Indications and Selection of Patients.- Preparation.- Operative Technique.- Post-operative Management.- Results.- Post-rectal Buttress Repair (Syn. Wyatt Technique).- Indications and Selection of Patients.- Preparation.- Operative Technique.- Post-operative Management.- Results.- 6 Circum-anal Techniques.- General Introduction.- Circum-anal Wire (or Nylon) Encirclement (Syn. Thiersch Procedure).- Indications and Selection of Patients.- Preparation.- Operative Technique.- Post-operative Management.- Circum-anal Cicatrical Fixation (Syn. Saraffof Technique).- Indications and Selection of Patients.- Operative Technique.- Post-operative Management.- Results.- Gracilis Muscle Sling Procedure (Syn. Pickrell-von Rapport Technique).- Indications and Selection of Patients.- Preparation.- Operative Technique.- Post-operative Management.- Results.- Stimulated Graciloplasty by B.J. Mander and N.S. Williams.- General Introduction.- Indications and Selection of Patients.- Preparation.- Operative Technique.- Stage 1.- Stage 2.- Post-operative Care Following Stage 2.- Results.- 7 Per-anal Techniques.- General Introduction.- Anterior (Rectal) Mucosectomy.- Indications and Selection of Patients.- Preparation.- Operative Technique.- Post-operative Management.- Rectal Wall Plication (Syn. Delorme Technique).- Indications and Selection of Patients.- Preparation.- Operative Technique.- Post-operative Management.- Rectosigmoidectomy (Syn. Altemeier Technique).- Indications and Selection of Patients.- Preparation.- Operative Technique.- Post-operative Management.- Results.- 8 Technique of Anal Sphincter Repair (Syn. Overlap Technique).- Indications and Selection of Patients.- Preparation.- Operative Technique.- Post-operative Management.- Results.- 9 Techniques for Congenital Anal Deformity Encountered in Later Life.- General Introduction.- Identification and Assessment of Abnormality.- General Principles Underlying the Operations.- Selection and Preparation of Patients for Surgery.- Covered Anus Deformity with Associated Perineal Fistula ("False Anus").- Anterior Ectopic Deformity.- No Definite Anal or Puborectalis Muscle.- Ectopic Opening Adjacent to an Anal Orifice ("Shot-gun Deformity").- Cloacal-type Deformity.- Post-operative Management.- Summary.- 10 Techniques for Repair of Traumatic Injury of the Anal Sphincters.- General introduction.- Indications and Selection of Patients.- Preparation.- Acute Primary Repair of Traumatised Anal Sphincter and Pelvic Floor.- Operative Technique.- Post-operative Management.- Trans-vaginal Injury to the Anus and Rectum.- Immediate Repair of Acute Trans-vaginal Injury.- Operative Technique.- Post-operative Management.- Delayed Repair of Chronic Unhealed Recto-vaginal Septal Defect.- Preparation.- Operative Technique.- Post-operative Management.- 11 Techniques for Repair of Recto-vaginal Fistula.- I: Low Recto-vaginal Fistula Repairs.- General Introduction.- Indications and Selection of Patients.- Preparation.- Excision and Repair of Low Juxtasphincteric Fistula.- Operative Technique.- Post-operative Management.- Per-vaginal Direct Repair of Low Supra-sphincteric Fistula.- Operative Technique.- Post-operative Management.- Per-anal Closure of Low Supra-sphincteric Fistula by Advancement Flap.- Operative Technique.- Post-operative Management.- II: High Recto-vaginal Fistula Repairs.- General Introduction.- Indications and Selection of Patients.- Preparation.- Direct Closure Using Interposed Omental Graft.- Operative Technique.- Post-operative Management.- Extended Resection with Colo-anal Anastomosis.- Operative Technique.- Post-operative Management.- 12 Salvage Procedures.- General Introduction.- Silastic Sling Encirclement.- Inflatable Anal Prosthesis.- Faecal Diversion (by a Stoma).- 13 General Supportive Measures.- General Introduction.- Enhancement of Sphincter Responses to Sensory Stimuli by Biofeedback.- Improvement of Anal Sphincter Tone and Reactivity.- Enhancement of the Efficiency of Rectal Emptying.- Alteration of the Consistency of the Stools.- Reduction of Colonic Motor Activity.- Promotion of Increased Patient Awareness and Co-operation.