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Unsuspected sphincter defects shown by anal endosonography after anorectal surgery

A prospective study

  • Original Contributions
  • Published:
Diseases of the Colon & Rectum

Abstract

PURPOSE: Anorectal surgery can lead to fecal soiling and incontinence. Whether surgery changes the anatomy and causes symptoms is unknown. Anatomic changes can be visualized by anal endosonography. METHODS: We studied 50 patients after hemorrhoidectomy (24), fistulectomy (18), and internal sphincterotomy (8). Symptoms were assessed, and anal endosonography, anal manometry, mucosal electrosensitivity, and neurophysiologic tests were performed. RESULTS: In 23 (46 percent) patients, a defect of the anal sphincter was found (13 patients had an internal sphincter defect, 1 had an external sphincter defect, and 9 had a combined sphincter defect), 3 after hemorrhoidectomy, 13 after fistulectomy, and 7 after internal sphincterotomy. Seven patients had symptoms, and they all had a sphincter defect. In the other 16 of 23 patients (70 percent), the sphincter defect did not produce symptoms. An internal sphincter defect lowered maximum basal pressure and shortened sphincter length. CONCLUSION: Anal endosonography can reveal sphincter defects after anorectal surgery. Seventy percent of the patients in this group had no complaints; therefore, defects were unsuspected. This has clinical implications in the evaluation of patients with fecal incontinence.

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Authors and Affiliations

  1. Department of Surgery, Free University Hospital, Amsterdam, The Netherlands

    Robertine van Baren M.D. & Miguel A. Cuesta M.D., Ph.D.

  2. Department of Gastroenterology, Free University Hospital, P.O. Box 7057, 1007, MB Amsterdam, The Netherlands

    Richelle J. F. Felt-Bersma M.D., Ph.D. & Martine Koorevaar B.S.

  3. Department of Neurophysiology, Free University Hospital, Amsterdam, The Netherlands

    Rob L. Strijers M.D., Ph.D.

Authors
  1. Richelle J. F. Felt-Bersma M.D., Ph.D.
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  2. Robertine van Baren M.D.
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  3. Martine Koorevaar B.S.
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  4. Rob L. Strijers M.D., Ph.D.
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  5. Miguel A. Cuesta M.D., Ph.D.
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Additional information

Read in part at the meeting of The British Society for Gastroenterology, Warwick, United Kingdom, September 15 to 17, 1993.

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Felt-Bersma, R.J.F., van Baren, R., Koorevaar, M. et al. Unsuspected sphincter defects shown by anal endosonography after anorectal surgery. Dis Colon Rectum 38, 249–253 (1995). https://doi.org/10.1007/BF02055596

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  • DOI: https://doi.org/10.1007/BF02055596

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