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Hernia – incidence
Hernia – incidence

...  Spigelian ...
Chapter 24: Nutrition, Metabolism, and
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Slide 1
Slide 1

... •By sliding four layers of tissue together, this technique is considered a more secure closure of the hole in the abdominal wall than the single-layer Bassini repair. In addition, the Shouldice technique uses the deepest layers of muscle while the Bassini repair uses more superficial layers. •High s ...
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Surgical management of fecal incontinence

In fecal incontinence (FI), surgery may be carried out if conservative measures alone are not sufficient to control symptoms. There are many surgical options described for FI, and they can be considered in 4 general groups. Much research has been conducted on the many surgical options, and their relative effectiveness is debated. Due to the lack of good quality evidence, it is impossible to identify or refute clinically important differences between the alternative surgical procedures. The ""optimal treatment regime may be a complex combination of various surgical and non-surgical therapies. Restoration and improvement of residual sphincter function sphincteroplasty (sphincter repair) Correction of anorectal deformities that may be contributing to FI Sacral nerve stimulation Replacement / imitation of the sphincter or its function Narrowing of anal canal to increase the outlet resistance without any dynamic component Anal encirclement (Thiersch procedure) Radiofrequency ablation (""Secca procedure"") Nondynamic graciloplasty (""bio-Thiersch"") Implantation/injection of microballoons, carbon-coated beads, autologous fat, silicone, collagen. Dynamic sphincter replacement Implantation of artificial bowel sphincter (neosphincter) Dynamic graciloplasty Antegrade continence enema (ACE)/ antegrade colonic irrigation Fecal diversion (stoma creation) A surgical treatment algorithm has been proposed for FI, although this did not appear to include some surgical options. Isolated sphincter defects may be initially treated with sphincteroplasty and if this fails, the patient can be assessed for sacral nerve stimulation. Functional deficits of the external anal sphincter (EAS) and/or internal anal sphincter (IAS), i.e. where there is no structural defect, or only limited EAS structural defect, or with neurogenic incontinence, may be assessed for sacral nerve stimulation. If this fails, neosphincter with either dynamic graciloplasty or artificial anal sphincter may be indicated. Substantial muscular and/or neural defects may be treated with neosphincter initially.
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