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The first 25 slides, exactly as they appear. The full deck has 187 content slides.
General Surgery
Benign Disorders of the Anorectum (Pelvic Floor, Fissures, Hemorrhoids, and Fistulas)
Built from Maingot's Abdominal Operations
What’s inside
11 sections · 187 slides
Overview
- Scope of the topic
- Plan of the topic
Anatomy of the anorectum
The landmarks, muscles, nerves and vessels that every anorectal examination is read against
- The anorectum as a single unit
- Position and mobility of the rectum
- The puborectalis sling and the anorectal angle
- The anal canal and the two sphincters
- Autonomic nerve supply of the anorectum
- Somatic supply of the pelvic floor and external sphincter
- Course of the pudendal nerve
- Three anatomic points of reference
- Anoderm compared with perianal skin
- The dentate line and the limits of the anal canal
- Landmarks of the anorectum
- Muscle layers and glands of the anal canal
- Rectal columns, anal crypts and anal glands
- Sensation above and below the dentate line
- Arterial supply of the rectum and anal canal
- Venous drainage by two separate routes
- Vascular supply of the anus and rectum
Fecal incontinence
How continence is built, how it fails, and what can be measured and repaired
- Components of the normal continence mechanism
- Rectal capacitance and compliance
- Resting pressure and the internal sphincter
- The sampling reflex
- Voluntary control and pelvic floor tone
- Definition and impact of fecal incontinence
- Three mechanisms of fecal incontinence
- Mechanical incontinence
- Neurogenic incontinence
- Idiopathic incontinence
- Causes of fecal incontinence
- History and physical examination
- Anal manometry and normal values
- Rectal sensation and tolerable volume
- Pudendal nerve terminal motor latency
- Normal pudendal nerve conduction tracing
- Transrectal ultrasound of the anal sphincter
- Normal anal sphincter on transrectal ultrasound
- Anterior sphincter defect on transrectal ultrasound
- Interpreting a sphincter defect and the role of MRI
- Pathway for evaluating and managing anal incontinence
- Conservative treatment of fecal incontinence
- Biofeedback and sensory retraining
- Predicting benefit from biofeedback
- Anal sphincter reconstruction
- Exposing and mobilising the torn sphincter
- Overlapping and securing the sphincter repair
- Results of overlapping sphincter repair
- Sacral nerve stimulation
- Muscle transfer and the artificial bowel sphincter
- Stoma as a definitive option
Rectal prolapse and internal intussusception
The rectum telescoping into itself, and eventually turning inside out through the anus
- Mechanism of rectal prolapse
- The three contributing components
- Consequences of rectal prolapse
- Defecographic appearance of prolapse
- Internal intussusception of the rectum
- Mucosal prolapse compared with full-thickness prolapse
- Radial folds of mucosal prolapse
- Concentric rings of full-thickness rectal prolapse
- Symptoms of rectal prolapse
- Examination and endoscopic findings
- Defecography in rectal prolapse
- Triple-contrast and newer imaging of the pelvic floor
- Defecography grading of intussusception
- Using the grading system to plan treatment
- Four families of operation for rectal prolapse
- Rectopexy
- Low anterior resection for prolapse
- Laparoscopic resection with a stapled colorectal join
- Functional trade-offs after low anterior resection
- Laparoscopic and ventral mesh rectopexy
- Perineal proctectomy
- Perineal removal of the prolapsed rectum with levator repair
- Results and limits of perineal proctectomy
- Anal encirclement procedures
- Conservative treatment of internal intussusception
- Operation for internal intussusception
- Preoperative tests before surgery for intussusception
- Stapled transanal rectal resection
Pelvic floor outlet obstruction and solitary rectal ulcer
A normal muscle used the wrong way: straining against a door that will not open
- Nature of pelvic floor outlet obstruction
- Vicious cycle of straining against a closed outlet
- Psychological associations
- Related presentations of outlet obstruction
- Solitary rectal ulcer syndrome
- Symptoms of pelvic floor outlet obstruction
- Digital examination and defecography
- Balloon expulsion test
- Surface electromyography and colonic transit study
- Pathway for pelvic floor outlet obstruction
- Treatment of outlet obstruction
Rectocele, enterocele and complex pelvic floor abnormalities
When the problem crosses compartments and needs more than one specialty
- Rectocele
- Repair of rectocele
- Enterocele
- Multidisciplinary management of complex pelvic floor disorders
Hemorrhoids
Normal anal cushions that have slipped down, and what to do about them
- Anal cushions
- How hemorrhoids develop
- Grading of internal hemorrhoids
- Anal skin tags and internal hemorrhoids
- Usual positions of the anal cushions
- External and mixed hemorrhoids
- External, internal and mixed hemorrhoids compared
- Evaluation of internal hemorrhoids
- Diet and bowel habit as first treatment
- Elastic ligation technique
- Rubber band ligation of an internal hemorrhoid
- Precautions during elastic ligation
- Complications of elastic ligation
- Management of post-ligation sepsis
- Practical points and other office procedures
- Indications for excisional hemorrhoidectomy
- Circular stapled hemorrhoidectomy
- Complications of stapled hemorrhoidectomy
- Incarcerated internal hemorrhoids
- Outcome after acute thrombosis of internal hemorrhoids
- Excision technique for mixed hemorrhoids
- Excision of a mixed hemorrhoid
- Avoiding anal stricture after hemorrhoidectomy
- Thrombosed external hemorrhoids
- Treatment of a thrombosed external hemorrhoid
Anal fissure
A small split in the anal lining that will not heal because the muscle beneath it will not relax
- Definition of an anal fissure
- Anal fissure at the anal verge
- Location of anal fissures
- The ischaemia and spasm cycle
- Chronic anal ulcer
- Fissures in atypical locations
- Recognising a Crohn's-related fissure
- Symptoms, examination and confirmation of anal fissure
- Stepwise treatment of anal fissure
- Conservative treatment and topical therapy
- Botulinum toxin injection
- Indications for surgery in anal fissure
- Open and closed lateral internal sphincterotomy
- Closed lateral internal sphincterotomy
- Open lateral internal sphincterotomy
- Results and risks of sphincterotomy
- Diamond skin advancement flap
- Mucosal ulcer at the anal verge and its excision
- Marking out the advancement flap
- Mobilising and advancing the flap
Anorectal abscess and anal fistula
One disease in two phases: the acute abscess, and the chronic track it leaves behind
- Cryptoglandular origin of abscess and fistula
- Where anorectal sepsis starts
- Cryptoglandular origin of abscess and fistula
- Perianal and ischiorectal abscess
- Supralevator abscess
- Spread of an intersphincteric abscess and the fistulas it leaves
- Timing of drainage and use of antibiotics
- Technique of abscess drainage
- Outcome after incision and drainage
- Goodsall's rule
- Goodsall's rule and unroofing of low fistulas
- Horseshoe fistula and the Hanley procedure
- Drainage of a horseshoe fistula
- Fistulotomy and the transsphincteric fistula
- Anterior midline fistula
- Endorectal advancement flap repair
- Advancement flap repair of a complex anal fistula
- Sphincter-sparing alternatives
- Assessment before rectovaginal fistula repair
- Non-cryptoglandular causes of anorectal sepsis
Sexually transmitted anal disease
Infections of the anus and rectum that surgeons are asked to see and must recognise
- Scope of sexually transmitted anorectal infection
- Appearances of anal human papillomavirus infection
- Dysplasia in anal human papillomavirus lesions
- Human papillomavirus types and cancer risk
- Anal intraepithelial neoplasia
- Detection and treatment of anal intraepithelial neoplasia
- Chlamydial infection of the rectum
- Behaviour of chlamydial organisms
- Presentation of chlamydial proctitis
- Diagnosis and treatment of chlamydial infection
- Anorectal herpes simplex virus infection
- Course, diagnosis and treatment of anorectal herpes
- Suppression and precautions in herpes
- Anorectal gonorrhea
- Diagnosis and treatment of rectal gonorrhea
- Primary anal syphilis
- Diagnosis of syphilis
- Secondary syphilis and treatment
- Precautions in treated syphilis
Bringing it together
The few ideas that make the whole of benign anorectal disease make sense
- Central anatomical ideas
- Central clinical principles
- References
- References (continued)
- References (continued)
- References (continued)
- References (continued)
- References (continued)
- References (continued)
- Maingot's Abdominal Operations, 12th Edition