Delorme's operation plus sphincteroplasty for complete rectal prolapse associated with traumatic fecal incontinence

Rectal prolapse associated with traumatic fecal incontinence is a rare clinical combination. This study was designed to assess Delorme＇s operation with sphincteroplasty as a surgical management of this combination in terms of recurrence and improvement of fecal incontinence. In this prospective study, we enrolled patients suffering from short, full-thickness rectal prolapse associated with traumatic fecal incontinence who had been admitted to Alexandria Main University Hospital during the period of May 2010-January 2013. Preoperative data including cause of trauma, duration of symptoms, results of anal manometry, and degree of fecal incontinence using Wexner score were collected from all patients. Delorme＇s procedure with overlap sphincteroplasty was done in all patients. Recurrence of prolapse and improvement of fecal incontinence were assessed after 1, 3, 6 and 12 months. The study included 13 patients aged （32±8.7） years, 9 females and 4 males. Cause of sphincteric injury included previous anal surgery in 7 patients and normal labor in 6 patients. Duration between sphinctefic injury and operation was （8.08±2.47） months. Preoperative Wexner＇s mean score was 16.07±3.4. Early postoperative complications included superficial wound infection （69.2%）, minor wound dehiscence （61.5%）, and postoperative bleeding （7.6%）. Recurrence was detected in 1 patient at 6 month follow-up. Wexner＇s score showed significant improvement for all patients after 6 months （4.00±2.04）. In conclusion, combination of Delorme＇s procedure and sphincteroplasty for treatment of patients with short complete rectal prolapse associated with traumatic fecal incontinence is a safe, effective surgical management with satisfactory results regarding anatomical and functional outcomes.

Selective sphincteroplasty of the papilla in cases at risk due to atypical anatomy

AIM： To analyze the indications, efficacy and safety of sphincteroplasty in our centre.METHODS： A retrospective study of sphincteroplasty in 53 cases of papilla at high risk was performed in 2004-2006. The procedure consisted of duodenoscopy with Olympus TJF 145 Videoduodenoscope, approach to the biliary tract using a catheter with a guidewire, and dilatation of the papilla with a dilatation balloon catheter using a syringe with a manometer for control of the filling pressure.RESULTS： The indications included intradiverticular papilla in 26 patients （49%）, stenosis of a previous sphincterotomy in 19 patients （35.8%）, small size of the papilla in 4 patients （7.5%）, Billroth R gastrectomy in 3 patients （5.6%）, and coagulopathy in one patient （1.9%）. The efficacy was 97.8%, with all the calculi extracted from the common bile duct in 84.4% of the patients, even though 21 of the patients （39.6%） had calculi with a diameter equal to or greater than 10 ram. Seven patients （13.2%） presented complications： haemorrhage in 1 patient （1.9%） and mild pancreatitis in 6 patients （11.3%）. The mean hospital stay in case of complications was of 3 ± 0.63 d.CONCLUSION： Sphincteroplasty is highly effective, with a compllcation rate similar to that of sphincterotomy, furthermore, the complications are of low clinical importance. The use of the 10 mm balloon makes it possible to extract calculi with a diameter of over 15 mm and to extract more than 3 calculi without increasing the rate of complications and reduces the need to resort to lithotripsy or rescue sphincterotomy.

Sphincteroplasty for fecal incontinence in the era of sacral nerve modulation

The role of sphincteroplasty in the treatment of patients with fecal incontinence due to anal sphincter defects has been questioned because the success rate declines in the long-term.A new emerging treatment for fecal incontinence,sacral nerve stimulation,has been shown to be effective in these patients.However,the success rate of sphincteroplasty may depend of several patient-related and surgical-related factors and the outcome from sphincteroplasty has been evaluated differently(with qualitative data) from that after sacral nerve stimulation(quantitative data using scoring systems and quality of life).Furthermore,the data available so far on the longterm success rate after sacral nerve modulation do not differ substantially from those after sphincteroplasty.The actual data do not support the replacement of sphincteroplasty with sacral nerve stimulation in patients with fecal incontinence secondary to sphincter defects.

Efficacy and safety of sphincterotomy with sphincteroplasty using large caliber balloons in the treatment of choledocholithiasis with extraction difficulties

Introduction: Endoscopic retrograde cholangiopan-creatography (ERCP) with endoscopic sphincterotomy (ES) is the most widely used technique for treating choledocholithiasis. In some cases, due to anomalies of the papilla or the presence of large or multiple calculi, additional maneuvers are needed to remove the stones. The present study investigates the efficacy and safety of ES with sphincteroplasty (SP) in the management of choledocholithiasis with extraction difficulties. Patients and Methods: A prospective study was made of 153 patients with choledocholithiasis subjected to ERCP. Fifty-two patients underwent ES with SP, while 101 were subjected only to ES. The two groups were compared in terms of age, gender, percentage cannulation, presence of papilla alterations, large or multiple stones, success in stone removal and complications (acute pancreatitis, bleeding and perforation). In the ES with SP group, we moreover recorded the diameters of the balloons employed (10-18 mm). Results: There were no significant differences between the groups in the stone extraction success rate (94.23% in the ES with SP group versus 97.03% in the ES group) or in the appearance of complications (3.8% in the ES with SP group versus 2.7% in the ES group). The presence of difficult papillae, and of multiple or large stones was significantly greater in the ES with SP group. The diameter of the balloon was not associated with the appearance of complications. Conclusion: Endoscopic sphincterotomy with sphincteroplasty is effective and safe in the treatment of choledocholithiasis with extraction difficulties.

Prior minimal endoscopic sphincterotomy to prevent pancreatitis related to endoscopic balloon sphincteroplasty

AIM To investigate the efficacy of prior minimal endoscopic sphincterotomy(EST) to prevent pancreatitis related to endoscopic balloon sphincteroplasty(EBS).METHODS After bile duct access was gained and cholangiogram confirmed the presence of stones < 8 mm in the common bile duct at endoscopic retrograde cholangiography, patients were subjected to minimal EST(up to one-third of the size the papilla) plus 8 mm EBS(ESTEBS group). The incidence of pancreatitis and the difference in serum amylase level after the procedure were examined and compared with those associated with 8-mm EBS alone in 32 patients of historical control(control group).RESULTS One hundred and five patients were included in the EST-EBS group, and complete stone removal was accomplished in all of them. The difference in serum amylase level after the procedure was- 25.0(217.9) IU/L in the EST-EBS group and this value was significantly lower than the 365.5(576.3) IU/L observed in the control group(P < 0.001). The incidence of post-procedure pancreatitis was 0%(0/105) in the EST-EBS group and 15.6%(5/32) in the control group(P < 0.001).CONCLUSION Prior minimal EST might be useful to prevent the elevation of serum amylase level and the occurrence of pancreatitis related to EBS.

肝内胆管结石行Oddi括约肌成形术15例长期随访报告

目的 评价Oddi括约肌成形术治疗肝内胆管结石的远期随访结果 ;分析内镜下乳头括约肌切开术 (endoscopicsphincterotomy,EST)治疗肝内胆管结石的合理性。 方法 回顾性分析我院肝内胆管结石行Oddi括约肌成形术的 15例长期随访资料 ,比较手术前后胆管炎和重症胆管炎发生率差异。 结果 15例随访 3～ 2 2年 ,平均 11 5年 ,术后残余结石 4例 ( 4 /15 ,2 6 7% ) ,胆管狭窄未纠正者 3例 ( 3/ 11,2 7 3% ) ,结石复发 4例 ( 4 / 15 ,2 6 7% ) ,死亡 1例 ( 1/ 15 ,6 7% )。手术后胆管炎复发率为 86 7% ( 13/ 15 ) ,手术前后无显著性差异 ( χ2 =0 5 ,P >0 0 5 ) ;手术后重症胆管炎发生率为 2 6 7% ( 4 / 15 ) ,手术前后无显著性差异 ( χ2 =1 33,P >0 0 5 )。 结论 处理肝内胆管结石必须彻底处理胆道上游的病变。在不了解肝内胆管是否伴有胆管狭窄等病变时 。

十二指肠良性肿瘤的手术治疗

目的探讨十二指肠良性肿瘤的诊断和治疗方法。方法回顾性分析18例经病理证实的十二指肠良性肿瘤的临床资料，包括临床症状、诊断方法、病灶部位、手术方式、病理结果和预后等。结果18例患者均行手术切除治疗，其中8例行局部切除术，1例行肠段切除术，1例行胃大部切除术，3例行乳头部肿瘤切除加括约肌成形术，5例行胰十二指肠切除术；病理检查证实腺瘤5例、管状腺瘤2例、绒毛状腺瘤2例、管状绒毛状腺瘤2例、错构瘤2例、错构瘤性息肉1例、Brunner腺瘤1例、腺肌瘤1例、纤维瘤病1例、异位胰腺1例；经2～60个月随访，1例死于非相关疾病，1例失访，其余生活质量良好。结论上腹部不适和上消化道出血是十二指肠良性肿瘤最为常见的症状，手术切除是首选的治疗方法，且预后良好。

重建内外括约肌原位肛门再造术治疗低位直肠癌110例

目的：观察一种新的重建内外括约肌原位肛门再造术治疗治疗治疗位直肠癌的临床效果。方法：11例低位直肠癌患者接受重建内外括约肌原位肛门再造术，原位肛门再造采用结肠折叠重建内括约肌，耻骨直肠肌两断端交叉缝合重建外括约肌，结果：110例行此手术，1例术后死亡（死于冠心病），3例术后再次手术改为腹壁造瘘术，106例完全成功，根据席式再造肛门术后节便功能评定四分法评定节便功能，优69例，良25例。一般12例，结论：采用Mile′s根治术后，重建内外括约肌1期原位肛门再造术，是治疗低位直肠癌较为理想，符合生理的术式，患者乐于接受，值得大力推广。

成人大便失禁的诊断和治疗

本文阐述成人大便失禁的定义、病因和大便失禁的治疗。初始治疗包括支持治疗和药物治疗,如果初始治疗失败,需要进一步作肛门直肠测压、直肠腔内超声和MRI检查,明确引起大便失禁的功能和结构的异常,以指导后续治疗。对于初始治疗失败的病人,治疗选择可以考虑生物反馈、注射肛门膨胀剂、骶神经刺激和肛门括约肌成形术。动力性股薄肌成形术和人工肛门括约肌可用于顽固性大便失禁的治疗,但并发症发生率高;对于顽固性大便失禁病人,不适合作其他治疗,或其他治疗失败,可行粪便转流结肠造口术。

咽扩约肌成形术治疗腭咽闭合不全临床研究

目的 了解咽扩约肌成形术对腭裂术后腭咽闭合不全的治疗作用。方法 选择腭裂修复术后 1年以上 ,经语音训练仍有语言障碍 ,分别令其朗读《汉语腭裂字表》同时录音 ,然后 7名听力语音正常的医护人员试听录音并计算正确率 ,正确率在 70 %以下患者 3 0例 ,分别行咽扩约肌成形术治疗。结果 术前语音正常 0人 ,基本正常 0人 ,中度发音异常1 1人 ,明显发音异常 1 4人 ,严重发音异常 5人。术后语音正常 1 6人 ,基本正常 1 1人 ,中度发音异常 2人 ,明显发音异常1人 ,严重发音异常 0人。结论 咽扩约肌成形术能使腭裂术后仍有腭咽闭合不全患者语音明显改善。

Oddi括约肌切开成形术疗效观察(附181例分析)

对109例行Oddi括约肌切开成形术的病人进行近远期随访,其优、良率为91.7%,除与适应证的选择及手术操作有关外,本组注意观察胆总管横径与括约肌切开长度之间的关系,二者之比为1∶1.25～1∶1.30,即 Oddi 括约肌切开长度略长于胆总管横径。

重建肛门外括肌和直肠肛管角治疗先天性肛门闭锁肛门成形术后大便失禁(附32例报告)

目的:观察重建肛门外括肌和直肠肛管角治疗先天性肛门闭锁肛门成形术后大便失禁的临床疗效。方法:对32例先天性肛门闭锁肛门成形术后大便失禁患者用股薄肌重建肛门外括肌并重建直肠肛管角。结果:32例患者术后随访1年,肛门功能优19例,良9例,较好4例,无效者未发现,总满意率为87·5%(28/32)。结论:用股薄肌重建肛门外括肌并重建直肠肛管角,术后患者肛门功能满意率高,患者生活质量明显提高。

咽扩约肌成形术治疗腭裂临床效果评价

目的 了解咽扩约肌成形术在治疗腭裂中临床效果。方法 腭裂修复时同期咽扩约肌成形 ,并对部分 3年以上患者 36人与同期用咽后壁瓣移植术后患者 30人进行比较 ,分别令其朗读《汉语腭裂字表》同时录音 ,然后 7名听力语音正常的医护人员试听录音并计算正确率。结果 咽扩约肌成形组 :语音正常 2 5人 (6 9.4% ) ,基本正常 8人 (2 2 2 % ) ,中度发音异常 2人 (5 6 % ) ,明显发音异常 1人 (2 8% ) ,严重发音异常 0人。咽后壁瓣移植组 :语音正常 15人 (5 0 0 % ) ,基本正常 7人 (2 3 3% ) ,中度发音异常 5人 (16 7% ) ,明显发音异常 2人 (6 7% ) ,严重发音异常 1人 (3 3% )。结论 咽扩约肌成形术后能使腭裂患者语音明显改善 。

Fecal incontinence - Challenges and solutions

Fecal incontinence is not a diagnosis but a frequent and debilitating common final pathway symptom resulting from numerous different causes. Incontinence not only impacts the patient&#x02019;s self-esteem and quality of life but may result in significant secondary morbidity, disability, and cost. Treatment is difficult without any panacea and an individualized approach should be chosen that frequently combines different modalities. Several new technologies have been developed and their specific roles will have to be defined. The scope of this review is outline the evaluation and treatment of patients with fecal incontinence.

Current management of fecal incontinence:Choosing amongst treatment options to optimize outcomes

The severity of fecal incontinence widely varies and can have dramatic devastating impacts on a person’s life.Fecal incontinence is common,though it is often underreported by patients.In addition to standard treatment options,new treatments have been developed during the past decade to attempt to effectively treat fecal incontinence with minimal morbidity.Non-operative treatments include dietary modifications,medications,and biofeedback therapy.Currently used surgical treatments include repair(sphincteroplasty),stimulation(sacral nerve stimulation or posterior tibial nerve stimulation),replacement(artificial bowel sphincter or muscle transposition)and diversion(stoma formation).Newer augmentation treatments such as radiofrequency energy delivery and injectable materials,are minimally invasive tools that may be good options before proceeding to surgery in some patients with mild fecal incontinence.In general,more invasive surgical treatments are now reserved for moderate to severe fecal incontinence.Functional and quality of life related outcomes,as well as potential complications of the treatment must be considered and the treatment of fecal incontinence must be individualized to the patient.General indications,techniques,and outcomes profiles for the various treatments of fecal incontinence are discussed in detail.Choosing the most effective treatment for the individual patient is essential to achieve optimal outcomes in the treatment of fecal incontinence.

咽扩约肌成形术治疗腭裂临床效果评价

目的 了解咽扩约肌成形术在治疗腭裂中临床效果。方法 腭裂修复时同期咽扩约肌成形 ,并对部分 3年以上患者 36例与同期用咽后壁瓣移植术后患者 30例进行比较 ,分别令其朗读《汉语腭裂字表》同时录音 ,然后 7名听力语音正常的医护人员试听录音并计算正确率。结果 咽扩约肌成形组 :语音正常 2 5例 (6 9.44 % ) ,基本正常 8人 (2 2 .2 2 % ) ,中度发音异常 2例 (5 .5 6 % ) ,明显发音异常 1例 (2 .78% ) ,严重发音异常 0例。咽后壁瓣移植组 :语音正常 15例 (5 0 .0 0 % ) ,基本正常 7例 (2 3.33% ) ,中度发音异常 5例 (16 .6 7% ) ,明显发音异常 2例(6 .6 7% ) ,严重发音异常 1例 (3.33% )。结论 咽扩约肌成形术后能使腭裂患者语音明显改善 ,临床效果优于咽后壁瓣移植术。

经十二指肠Oddi括约肌切开成形术在治疗胆总管下段嵌顿性结石的应用

目的探讨经十二指肠Oddi括约肌切开成形术在治疗胆总管下段嵌顿性结石中的临床应用。方法回顾性分析本院1988年1月至2009年4月应用经十二指肠Oddi括约肌切开成形术治疗胆总管下段嵌顿性结石29例临床资料,并进行6个月至15年的随访。结果治愈出院28例,死亡1例。并发切口感染5例,急性胰腺炎3例,十二指肠瘘1例。23例获得随访,发生反流性胆管炎3例,胆总管复发结石2例,急性胆管炎并左肝内胆管结石1例,胆管下端癌1例。结论应用经十二指肠Oddi括约肌切开成形术治疗胆总管下段嵌顿性结石安全可靠,符合生理的胆汁引流,能有效预防术后结石复发,近远期疗效较好,尤其适用于合并胆总管下段良性狭窄的病例。

Sphincteroplasty for anal incontinence

Sphincteroplasty(SP)is the operation most frequently performed in patients suffering from moderate-to-severe anal incontinence(AI)who do not respond to conservative treatment.Other costly surgeries,such as artificial bowel sphincter(ABS)and electro-stimulated graciloplasty,have been more or less abandoned due to their high morbidity rate.Minimally invasive procedures are widely used,such as sacral neuromodulation and injection of bulking agents,but both are costly and the latter may cure only mild incontinence.The early outcome of SP is usually good if the sphincters are not markedly denervated,but its effect diminishes over time.SP is more often performed for post-traumatic than for idiopathic AI.It may also be associated to the Altemeier procedure,aimed at reducing the recurrence rate of rectal prolapse,and may be useful when AI is due either to injury to the sphincter,or to a narrowed rectum following the procedure for prolapse and haemorrhoids(PPH)and stapled transanal rectal resection(STARR).The outcome of SP is likely to be improved with biological meshes and post-operative pelvic floor rehabilitation.SP is more effective in males than in multiparous women,whose sphincters are often denervated,and its post-operative morbidity is low.In conclusion,SP,being both low-cost and safe,remains a good option in the treatment of selected patients with AI.

Redo sphincteroplasty:are the results sustainable?

Objective:This study aimed to investigate the long-termoutcomes of patients who undergo redo sphincteroplasty(RS).Methods:Patients with fecal incontinence(FI)who underwent RS between November 1988 and December 2011 were retrospectively identified from a prospective database.A questionnaire and telephone survey assessed current Cleveland Clinic Fecal Incontinence Score(CCFFIS;best 0,worst 20)and Fecal Incontinence Quality of Life(FIQoL;best 4.1,worst 1)scale.Success was defined as no further continence surgery,no stoma and CCFFIS<9 at completion of follow-up.The Wilcoxon and Mann-Whitney U tests were used for comparing quantitative variables.Bivariate logistic regression analysis was done to identify predictive factors for success.Results:Fifty-six(66.7%)of 84 patients who underwent RS were available for evaluation at a median follow-up of 74(range:12-283)months.The mean CCFFIS decreased from 16.563.7 to 11.966.6(P<0.001)at last follow-up.Twelve patients(21.4%)underwent further continence surgery for failed sphincteroplasty,three(5.4%)of whom had a permanent stoma.Eighteen patients(32.1%)had a CCFFIS<9 at the completion of follow-up,and 16(28.6%)had long-term success.Twentyfour patients evaluated for FIQoL had a mean value of 2.6(range:1.0-4.1).Postoperative CCFFIS was correlated with FIQoL(Spearman’s correlation coefficient?0.854,P<0.001).Logistic regression analysis did not reveal any significant predictive variables for success of RS.Conclusion:Based on our criteria for success,the long-term success rate for RS over a median of 74 months is poor.

Oddi括约肌切开成形术168例临床分析

目的 探讨经十二指肠Oddi括约肌切开成形术的适应证和手术技术。方法 19841999年 ,经十二指肠Oddi括约肌切开成形术 168例。全组随访 13 0例 ,随访时间 110年 ,随访率 77 2 7% (13 0 /168)。结果 术后近期并发症 12例 ,远期 5例 ,死亡 2例。效果优良率为 91 76% (119/13 0 )。结论 严格掌握适应证 ,熟练操作技巧 ,90