Prevention and Treatment of Complications in Proctological Surgery

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Proctological - definition of proctological by The Free Dictionary

Rehabilitation comprehensive colorectal cancer programm individualization. Naukovii vistnik Ujgorodskogo universitetu. Kehlet H. Canadian Jornal of Anesthesia. Fast track surgery - a multimodal strategy for managing surgical patients. Kazanskiy medicinskiy zhurnal. Wodlin NB, Nilsson L. The development of fast-track principles in gynecological surgery.

Acta Obstet. Klinicheskaja oncologaja. Ann Surg. Immunonutrition in gastrointestinal surgery. Br J Surg.


  • What is fecal incontinence??
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This work is licensed under a Creative Commons Attribution 4. Open Science in Ukraine. Skip to main content Skip to main navigation menu Skip to site footer. Abstract Objective. Author Biographies B. How to Cite. Complex prophylaxis of postoperative complications in colorectal surgery. Klinicheskaia Khirurgiia , 86 6 , Each time the muscles of the anal sphincter contract around the probe, the device senses it.

This can give the patient an idea of the patterns of their muscle activity. By practicing muscle contractions and viewing their strength and response on a screen, the patient can learn to strengthen those muscles. Stool impaction treatment may be needed to remove an impacted stool, if other treatment is not effective.

Fecal Incontinence

The surgeon uses two gloved fingers to break the stool into small pieces, making it easier to expel. If the problem is caused by fecal impaction, and other treatments are ineffective, an enema may help. A small tube is placed into the anus, and a special solution is inserted to wash out the rectum. In sacral nerve stimulation, four to six small needles are inserted into the muscles of the lower bowel. The muscles are stimulated by an external pulse generator that emits electrical pulses.

Patients who respond well to this treatment may have permanent pulse generator, similar to a pacemaker, implanted under the skin of the buttock. The sacral nerve runs from the spinal cord to muscles in the pelvis and is involved in bowel and urinary continence. Surgery is normally only used if other treatments have not worked or to treat an underlying condition. Sphincteroplasty is surgery to repair a damaged or weakened anal sphincter.

The surgeon removes damaged muscle, overlaps the muscle edges and sews them back together.

Topic Overview

This provides extra support to the muscles and tightens the sphincter. Stimulated graciloplasty, or gracilis muscle transplant, uses a small amount of muscle from the patient's thigh to create an artificial sphincter. Electrodes attached to a pulse generator are inserted into the artificial sphincter, and impulses gradually change the way the muscles work.

Sphincter replacement uses an inflatable cuff to replace damaged anal sphincter. The cuff is implanted around the anal canal. When inflated, the cuff keeps the anal sphincter firmly shut until the person is ready to defecate. A small external pump deflates the device, allowing the stool to be released. The device then reinflates automatically about 10 minutes later. Surgery for a prolapsed rectum may be done if other treatments have not worked. The sphincter muscle may be repaired at the same time. A rectocele may be corrected by surgery, if it leads to significant symptoms of fecal incontinence.

Use of Patient Complaints to Identify Surgeons with Increased Risk for Postoperative Complications

Prolapsed internal hemorrhoids may prevent the anal sphincter from closing properly, resulting in bowel incontinence. Hemorrhoidectomy is a surgical procedure to remove them. A colostomy can be used as a last resort. The stools are diverted through a hole in the colon and through the wall of the abdomen.

A special bag is attached to the opening to collect the stool. Chronic fecal incontinence can involve frequent or occasional accidental leakage, an inability to hold in gas, silent leakage of feces during daily activities or exertion, or not reaching the bathroom in time.

Fecal incontinence can be a relatively small problem, resulting in the occasional soiling of underwear, or it can be devastating, with a total lack of bowel control. After digesting food, the digestive system moves waste, or feces toward the rectum, the tube that links the intestines to the anus. The rectum stores the waste until the body is ready to expel it.

As the rectum fills up, the rectal walls expand. Stretch receptors, or nerves, in the rectal walls stimulate the desire to defecate. If the person does not defecate on feeling this urge, the stools may return to the colon, where more water is absorbed. When the rectum is full, the increased pressure forces the walls of the anal canal apart, and peristaltic waves push the feces into the canal. As stools enter the anal canal, the rectum shortens. Internal and external sphincters allow the stools to be passed by causing muscles to pull the anus up over the exiting feces.

The internal sphincter works automatically and unconsciously, while the external sphincter responds when we want it to. The sphincter muscles do not work as they should. Childbirth can cause the sphincter muscles to become stretched and torn, especially if forceps or other devices are used during delivery, or if the mother had an episiotomy. A complication of bowel or rectal surgery and some other types of injury can also cause damage to the sphincter muscles. Diarrhea can make it difficult for the rectum to hold the stools.

Stenosis after Stapled Anopexy: Personal Experience and Literature Review

Recurring diarrhea, due, for example, to Crohn's disease , irritable bowel syndrome IBS , or ulcerative colitis, can lead to scarring in the rectum and bowel incontinence. Constipation can lead to bowel incontinence. If solid stool becomes impacted, it may be too hard to come out. The muscles of the rectum can stretch and weaken, and watery stools may then leak around the impacted stool and seep out of the anus. This is called overflow of the bowel. Certain foods can foods cause diarrhea and worsen the symptoms of fecal incontinence in some people. Examples include spicy, fatty, or greasy foods, cured or smoked meats, and dairy products for those with a lactose intolerance.

A physician will ask about symptoms, bowel habits, diet, medical history, lifestyle, and so on. The individual should explain openly, honestly and comprehensively, to find the best treatment. The doctor may examine the patient's anus and surrounding area for any damage, hemorrhoids, infections, and other conditions. They may use a pin or probe to examine this area of skin and check for nerve damage. A digital rectal examination DRE may be necessary, in which the surgeon inserts a sterile gloved finger into the anus and up into the rectum.

Further tests may require the help of a gastroenterologist, a doctor specialized in conditions and diseases of the digestive system or a proctologist, who specializes in conditions and diseases of the rectum and the anus. Endoscopy involves inserting an endoscope, a long, thin flexible tube with a light source and video camera at the end, through the anus into the rectum.

Images on a screen may reveal any obstruction, damage, or inflammation in the rectum. In anal manometry, the doctor inserts a narrow, flexible tube into the patient's rectum via the anus. A balloon at the tip is then expanded. This can assess how tight the anal sphincter is, how sensitivity the nerves are, and how well the muscles are functioning.


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An anorectal ultrasound scan can evaluate the structure of the sphincter. A narrow, wand-like device is inserted into the anus and rectum. It produces video images of internal structures by emitting sound waves that bounce off the walls of the rectum and anus. Defecography, or protography, involves taking x-ray images with barium liquid. The patient will be asked to pass a stool while the x-rays are taken. This can determine how much stool the rectum can hold, and how well the stools are evacuated. In anal electromyography, tiny needle electrodes are inserted into the muscle around the anus.

Treatment of Postoperative Complications After Digestive Surgery

A light electrical current is sent through the electrodes, and signals show up as images on a screen. This can reveal any damage to the nerves between from the rectum to the brain, and it may show where the damage is.

Do we have to stop anticoagulant and platelet‐inhibitor treatments during proctological surgery?

While waiting to find a successful treatment, a range of discreet products and pads are available to help people cope with incontinence without embarrassment. Article last updated by Yvette Brazier on Tue 9 January All references are available in the References tab.



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