Anorectal: Anal Incontinence Procedures

Sphincteroplasty

Basics

  • Surgical Recreation of the Anal Sphincter
  • Preferred Preoperative Defect Size: 60-180 Degrees
    • Typically No Benefit if Smaller or Larger/Multi-Segmental

Procedure

  • Position: Prone-Jackknife
  • Make Transverse Curvilinear Incision Between the Rectum & Vagina
  • Dissect Down to Expose the Sphincter Muscles
  • Mobilize the Scarred Ends to Allow Overlap
    • Excessive Mobilization Risks Denervation or Ischemia
  • Attach the Muscle Ends at the Scar Edges Together Using Absorbable Mattress Suture

Outcomes

  • 74-86% Improved Continence at 3 Months
  • 40% Improved Continence at 80 Months

Sacral Nerve Stimulator

Basics

  • Direct Low-Voltage Stimulation of Sacral Nerve Roots
  • Preformed in 2 Stages
  • Becoming the Preferred Approach

Stage 1: Trial Phase

  • Percutaneous Lead Placement into the S3 Foramen
  • Confirm with Intraoperative Stimulation – Causes Pelvic Floor Contraction & Great Toe Flexion
  • Leads Connected to External Stimulator
  • Success: ≥ 50% Reduction in Episodes After 2 Weeks

Stage 2: Permanent Placement

  • Remove Temporary Leads
  • Place Permanent Leads
  • Implant Stimulator within The Buttock Soft Tissue (Below the Iliac Crest)

Outcomes

  • 87% Had ≥ 50% Improvement
  • 40% Had Perfect Control
  • Long-Term Success Persists