By PD Dr. med. Andreas Huber, Prof. Dr. Arthur H. C. von Hochstetter, Prof. Dr. Martin Allgöwer (auth.)
ISBN-10: 0387125833
ISBN-13: 9780387125831
ISBN-10: 3540125833
ISBN-13: 9783540125839
ISBN-10: 3642694705
ISBN-13: 9783642694707
ISBN-10: 3642694721
ISBN-13: 9783642694721
More than a century in the past, Cripps effectively hired the direct and entire department of the anal sphincters as a method of imminent the reduce rectum and anal canal, and mentioned on a chain of 36 sufferers who have been taken care of in that type. Cripps was once pleasantly stunned to discover reliable fecal continence in over two-thirds of the sufferers in the course of later follow-ups, even though the divided sphincters had no longer been repaired. The transsphincteric method was once principally forgotten in next years, even though, and merely the parasacral proctotomy of Kraske, which spared the anal sphincters, may be stated to have received a longtime position within the" surgical armamentarium. " It remained for York Mason to redirect the eye of the surgical neighborhood to the nice power of the trans sphincteric strategy and the superb continence that may be accomplished via enough fix of the divided sphincters. Having well-known the exceptional useful worth of this method, we felt it essential to outline extra exactly the anatomical necessities that may be sure minimal operative bleeding, and to carry the technique extra in keeping with present wisdom of ordinary continence and defecation. Dr. A. Huber, in session with the director of the Institute for scientific Anatomy of our surgical division, Prof. A. von Hochstetter, did many months of dissection paintings on clean anatomic arrangements so that it will discover and refine many of the features of the trans sphincteric ap proach.
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Additional info for Transsphincteric Surgery of the Rectum: Topographical Anatomy and Operation Technique
Example text
The levator insertion and anococcygeal ligament are detached from the tip of the sacrum (" posterior release "). The muscle layers are then divided between ligatures, whose ends are left long and marked with knots. Failure to mark the muscle layers at the time of division can make later identification and repair extremely difficult (cf. Fig. 19). Longitudinal Posterior Incision of the Pelvic Floor and Anal Canal 47 Fig. 18. A longitudinal posterior incision has been made through the sphincters and anal canal.
This drawing is of a male hemipelvis opened by means of a slightly parasagittal incision [cf. female hemipelvis in Fig. 7a, b (/)]. The rectum arises from the sigmoid colon at the point where the free sigmoid mesocolon terminates, or about at the level of the third sacral vertebra. The approximately i5-cm-long segment of rectum located above the rectal diaphragm (1) is known as the pars pelvina (2) or as the rectal ampulla when dilated. Below the rectal diaphragm is the pars perinealis of the rectum (3), which terminates at the anus (4).
The rectum is opened longitudinally between stay sutures (a). The lumen of the bowel is cleansed with a tissue-compatible antiseptic solution. A growth on the anterior wall of the rectum is easily recognized at this time. Benign tumors are curable by local resection. This is done by making a transverse elliptical excision about the tumor which includes a margin of normal mucosa (b). The mucosal defect is closed transversely with simple interrupted sutures (c). If a malignancy is present, then a sleeve resection is indicated (d).
Transsphincteric Surgery of the Rectum: Topographical Anatomy and Operation Technique by PD Dr. med. Andreas Huber, Prof. Dr. Arthur H. C. von Hochstetter, Prof. Dr. Martin Allgöwer (auth.)
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