29 July 2015

Озноб при анальной трещине

Сфинктеротомия при хронической анальной трещине

Сфинктеротомия при хронической анальной трещине - как это делать правильно?

Posterior sphincterotomy, which involves fissure excision and sphincterotomy through the same incision, leads to a high incidence of postoperative incontinence (Melange et al 1992). This is believed to be due to the keyhole deformity which commonly results from this procedure, allowing seepage of stool along a low pressure channel.

 

Lateral anal sphincterotomy (LAS) involves a controlled division of the internal anal sphincter at 3 or 9 o’clock (Notaras 1969). This may be performed under local anaesthetic, although there is evidence that a more effective sphincterotomy may be performed under general anaesthetic (Gatehouse et al. 1978).

 

Closed or open techniques seem to be comparable in terms of efficacy (Boulos & Araujo 1984).

 

Lateral sphincterotomy is generally a safe technique which effectively achieves fissure healing in most cases. However, a prospective endosonographic study has demonstrated that the degree of sphincterotomy is unpredictable, in 9 out of 10 women studied the internal sphincter was completely divided. Conversely, in the men studied, distal internal sphincter division only was apparent in 4 out of 5 patients (Sultan et al. 1994). The reported recurrence rates following lateral sphincterotomy range from 0.3 to 35%. Minor degrees  of incontinence are relatively common after this procedure (see Table 1.3.2). A meta-analysis of randomised controlled trials has demonstrated that the relative risk of incontinence (6.63, 95% confidence interval 2.06 - 21.3) was greater after anal stretch than after sphincterotomy (Nelson 1999).

 

 

Table 1.3.2 : Reported rates of incontinence following lateral anal sphincterotomy

Study

n

Incidence of faecal incontinence / %

 

 

Flatus

Liquid

Solid

Not spec

 

 

 

 

 

 

Notaras 1971

 

82

2.4

4.8

-

-

Abcarian 1980

 

300

30

5

-

-

Walker et al. 1985

 

306

6.2

2

-

-

Lewis et al. 1988

 

350

17

-

0.03

 

Khubchandani & Reed 1989

 

1355

35.1

22

5.3

-

Pernikoff et al. 1994

 

500

3

-

0.4

-

Oh et al. 1995

 

1313

-

-

-

1.5

Hananel & Gordon 1997b

 

312

0.3

0.3

0.3

-

Nyam & Pemberton 1999

585

6

8

1

-

 

 

1.1.1.1     Advancement flaps

The use of island advancement flaps have recently been described in the management of anal fissure (Nyam et al. 1995). In a controlled trial of 40 patients randomised to lateral sphincterotomy or advancement flap all fissures treated with sphincteromy healed, whereas three fissures treated with flap advancement failed to heal (Leong & Seow-Choen 1995). The formation of an advancement flap is relatively major surgery compared to lateral sphincterotomy and there is a high rate of flap separation and necrosis. However, this may be appropriate in selected patients who have had previous sphincterotomy or in patients with concomitant obstetric trauma (who may also require a sphincter repair).

Источник: http://proctology.dn.ua/analnaya-treshina/sfinkter...

Добавить комментарий!

Ваше Имя:
Ваш E-Mail:
Код:
Операция ав узловой тахикардии
Введите код:
Популярные новости
Можно ли суши при панкреатите?
Можно ли при панкреатите огурцы

Сфинктеротомия при хронической анальной трещине Сфинктеротомия при хронической анальной трещине - как это делать правильно? Posterior sphincterotomy, which involves fissure excision and sphincterotomy through the same incision, leads

Можно аппарат алмаг-01 использовать при грыже позвонка
Бросаем курить делимся опытом

Здравствуйте, дорогие друзья. Совсем недавно передо мной стала проблема приготовления обеда к приезду гостей. Если бы это были просто гости, то без проблем. Но я знала, что один из гостей

Клиника зрение смоленская