SURGICAL-MANAGEMENT OF ANORECTAL INJURIES

The surgical problems of traumatic sphincter lesions are reported comp aring early and late repair. In 11 acute injuries the surgical concept consisted generally of proximal fecal deviation, distal washout, reco nstruction of the muscular defects and presacral drainage. In soft tis sue injuries (grade I, n=2) complete healing without functional defici encies was obtained inspite of renouncing fecal diversion. In isolated ruptures of the rectum or the sphincter (grade II, n=3) and in comple te disruption of both components (grade III, n=4) after healing and cl osure of the temporary colostomy continence was estimated subjectively as being sufficient. Patients' overall-appraisal was not correlated t o the preoperative degree of destruction nor the postoperative measure ment of continence. Only when devascularisation of the anorectum with severe bleeding had occurred (grade IV, n=2) proctectomy was necessita ted resulting in one death. In none of 5 patients operated on elsewher e there was a chance of secondary sphincteric reconstruction. During o peration or endosonographically and electromyographically the sphincte r musculature could not be detected. Obviously renouncing of anatomica l reconstruction leads not only to retraction but also to secondary de generation of the sphincter muscles.