Surgical Treatment of Anal Incontinence

1 Essential Anatomy of Anal Continence.- General Introduction.- Structural Anatomy.- Surgical Anatomy.- 2 Physiology of Anal Continence.- General Introduction.- Applied Physiology.- 3 Abdominal Techniques.- General Introduction.- Abdominal Rectopexy with Prosthetic Implant (Syn. Wells Technique).- Abdominal Rectopexy with Prosthetic Sling (Syn. Ripstein Technique).- Abdominal Rectopexy plus Colon Resection (Syn. Goldberg Technique).- Laparoscopic Rectopexy for Rectal Prolapse.- 4 Anterior Perineal Techniques.- General Introduction.- Anterior Plication of Puborectalis and Anal Sphincter (Syn. Anterior Buttress Technique, Anterior Levatorplasty).- Anterior Sling Procedure (Syn. Notaras Technique).- 5 Posterior Perineal Techniques.- General Introduction.- Post-anal Intersphincteric Repair (Syn. Parks Technique. Posterior Levatorplasty).- Post-rectal Buttress Repair (Syn. Wyatt Technique).- 6 Circum-anal Techniques.- General Introduction.- Circum-anal Wire (or Nylon) Encirclement (Syn. Thiersch Procedure).- Circum-anal Cicatrical Fixation (Syn. Saraffof Technique).- Gracilis Muscle Sling Procedure (Syn. Pickrell-von Rapport Technique).- Stimulated Graciloplasty by B.J. Mander and N.S. Williams.- General Introduction.- Indications and Selection of Patients.- Preparation.- Operative Technique.- Post-operative Care Following Stage 2.- Results.- 7 Per-anal Techniques.- General Introduction.- Anterior (Rectal) Mucosectomy.- Rectal Wall Plication (Syn. Delorme Technique).- Rectosigmoidectomy (Syn. Altemeier Technique).- 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.- 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.- Acute Primary Repair of Traumatised Anal Sphincter and Pelvic Floor.- Trans-vaginal Injury to the Anus and Rectum.- Immediate Repair of Acute Trans-vaginal Injury.- Delayed Repair of Chronic Unhealed Recto-vaginal Septal Defect.- 11 Techniques for Repair of Recto-vaginal Fistula.- I: Low Recto-vaginal Fistula Repairs.- General Introduction.- Excision and Repair of Low Juxtasphincteric Fistula.- Per-vaginal Direct Repair of Low Supra-sphincteric Fistula.- Per-anal Closure of Low Supra-sphincteric Fistula by Advancement Flap.- II: High Recto-vaginal Fistula Repairs.- General Introduction.- Direct Closure Using Interposed Omental Graft.- Extended Resection with Colo-anal Anastomosis.- 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.