tailieunhanh - Fecal Incontinence Diagnosis and Treatment - part 9

Tỷ lệ cao không sửa chữa được kết hợp với xấp xỉ endto cho thấy rằng nó là một phương pháp không hiệu quả sửa chữa sphincters bị rách hậu môn. Các nhà điều tra đã cố gắng sửa chữa khác nhau và các phương pháp điều trị khác nhau | Chapter 30 Obstetric Lesions The Gynaecologist s Point of View 287 Table 4. Prevalence of persistent defect after anal sphincter repair Reference Number Interval Number with persisten t defect EAS IAS EAS IAS Total Sultan et al. 18 34 2-22 months 5 1 23 29 85 Poen et al. 21 40 1-11 years 23 0 12 35 88 Gjessing et al. 20 35 1-5 years 19 54 Nielsen et al. 19 24 3-18 months 13 1 0 14 58 Borello-France et al. 10 22 12 months 13 1 6 20 91 EAS external anal sphincter IAS internal anal sphincter Overlapping Repair The high rate of failed repair associated with the end-to-end approximation suggests that it is an ineffective method of repairing torn anal sphincters. Investigators have tried different repairs and various other ancillary therapies to improve the surgical outcome. One frequently suggested approach was to abandon the end-to-end approximation in favor of the overlapping repair. Although obstetricians primarily use the end-to-end approximation some investigators believe that this technique is inherently incapable of repairing the torn anal sphincter because the sphincter muscle and capsule are just not strong enough to hold the sutures in an end-to-end configuration. In contrast colorectal surgeons generally favor the overlapping repair. This method originally described in the early 1970s by Sir Allen Park distributes the tension on the sutures over a larger area to reduce the likelihood that they will tear through the sphincter muscle and capsule 24 . Two small case series seemed to suggest that the overlapping repair has a lower failure rate than end-to-end approximation 25 26 . Two British investigators used the overlapping technique to repair 32 anal sphincters torn during vaginal delivery 25 . After 20 weeks the authors reported that their subjects had a lower incontinence rate 40 vs. 8 and fewer failed repairs 85 vs. 15 than historical controls repaired with end-to-end approximation . A Swedish study found only one 3 failed repair among 30 cases of third- .