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Surgical treatment of anal incontinence and recto vaginal fistulas-Mukundapur

Surgical Treatment of Anal Incontinence and Recto Vaginal Fistulas

Surgical treatment of anal incontinence and recto vaginal fistulas in Mukundapur

Anal incontinence is the inability to control the elimination of faeces or stools. It can be associated with a loss of self-esteem and poor personal hygiene. Common causes of anal incontinence:

  • Diarrhoea: Weakens rectal and anal muscles.
  • Constipation: Straining can cause nerve damage and liquid stool seepage.
  • Muscle damage: From difficult vaginal delivery or anal or rectal surgery.
  • Nerve damage: From surgeries, difficult delivery, or chronic conditions.

Recto vaginal fistulas:

An abnormal connection that forms between the vagina and the rectum, or bottom part of the large intestine, is called a rectovaginaginal fistula. Gas or faeces may be able to enter the vagina due to bowel contents seeping through the fistula. A rectovaginal fistula can result from:

  • Childbirth injuries
  • Inflammatory bowel diseases like Crohn's disease
  • Ulcerative colitis causes tissue swelling and irritation
  • Cancer or radiation in the pelvic area, especially in the rectum, cervix, vagina, uterus, or anal canal
  • Pelvic surgeries, such as those involving the vagina, perineum, rectum, or anus

 

FAQ's

To repair a damaged anal sphincter muscle, Anal Sphincteroplasty surgery is required. An incision is created between the vagina and the anus during this procedure. The surgeon sutures together the sphincter muscle and other muscles between the rectum and vagina to ensure they are closed in multiple layers.

  • Bleeding: You will be given a blood transfusion if the bleeding is severe.

  • Bowel injury: In rare instances, a patient may sustain a bowel injury that can be corrected during the procedure.

  • Nerve damage: Doctors carefully position you in the operating room to avoid excessive pressure on your nerves while the procedure is being performed.

  • Blood clots in the legs or lungs: A blood clot that forms in the veins can disrupt the blood flow. If a clot develops in the leg, it causes swelling and pain. If the clot forms in the chest, it may cause shortness of breath and chest pain.

  • Infections: As with any injury, the patients are at risk of developing infections in the operating area.

The Implantable Artificial Bowel Sphincter (ABS) is based on the artificial urinary sphincter. These artificial sphincters are suitable for patients failing surgical repair or not suited for skeletal muscle transfer. The components of the sphincter include a cuff around the anal canal, a pressure-regulating balloon, and a pump in the scrotum. The patient controls continence by inflating/deflating the cuff, mimicking the action of a normal anal muscle. ABS shows promise for severe anal incontinence when standard therapy fails.

A tiny device known as a neurotransmitter is implanted under the skin in the upper buttock region to stimulate the sacral nerve. The sacral nerve, which is situated in the lower back, receives modest electrical impulses from this device. These impulses enhance control and function by regulating the muscles of the bladder, sphincter, and pelvic floor. The muscles involved in bowel and urine motions are primarily controlled by the sacral nerve. Patients with faecal or urine incontinence who have not responded to previous therapies are frequently treated with this therapy, which improves their quality of life.

It is appropriate for children with faecal incontinence or severe constipation. Your surgeon makes a tiny passageway that connects your colon to the skin of your belly. To remove the waste from your colon, they install a tiny tube that you use for a daily washout. The tiny tube is usually created on the right side of your abdomen or your belly button.

A Colostomy is a surgical procedure that reroutes the colon to a new opening in the abdominal wall, called a stoma, allowing waste to exit through this new pathway instead of the anus. A colostomy bag is typically worn to collect the waste. The need for a colostomy may be temporary or permanent, depending on the underlying condition. This operation often follows a Colectomy, where part or all of the colon is removed. Your healthcare provider will guide you through living with and caring for your colostomy.

A temporary Colostomy may be necessary for the following conditions:

  • Severe infection, such as ulcerative colitis.

  • Inflammatory bowel disease-related acute inflammation (IBD).

  • Acute injury to your colon.

  • A blockage in your colon or anus.

  • Incontinence of the anals.

  • Anal fistula: a passageway that extends from the anal cavity to the skin or another organ.

  • Rectovaginal fistulas.

  • Partial colectomies, in which the residual bowel ends can be reattached later.

Symptoms that a patient may experience with rectovaginal fistulas are:

  • Foul-smelling vaginal discharge
  • Gas, pus, or stools may leak out from the vagina
  • Painful intercourse
  • Abdominal pain
  • Recurrent urinary tract infections
  • Rectal or vaginal bleeds

Small rectovaginal fistulas heal on their own without requiring intervention. If infected, you may have to take antibiotics. If the fistula results from an inflammatory bowel disease, you may have to take medications. If medical management fails, you may have to opt for surgery.

Surgical approaches are always indicated for treating rectovaginal fistulas. Some of the procedures employed are:

  • Transanal Advancement Flap Repair: The flap extends above the fistula, with a wide base for adequate blood supply to the flap tip. The fistula tract is debrided (cleaned), and the flap is sutured in place, separating the suture line from the fistula site.

  • Transvaginal Inversion Repair: Suitable for small, low fistulas. Uses purse-string sutures to invert the fistula into the rectal lumen.

  • Bioprosthetic Repair: Involves a transverse incision, the closure of fistula openings, and the insertion of a bioprosthetic graft.

  • Simple Fistulotomy: Helps treat rectovaginal fistulas that do not have sphincter involvement. 

  • Bowel Resection: If abnormal tissues are present near the fistula, then repair is doomed to fail. Such cases are treated by employing various techniques of Bowel Resection.

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