Anal Sphincter Muscle Research Articles

Stromal cell derived factor 1 plasmid to regenerate the anal sphincters.

Under ethics approved protocol 19 age/weight matched Sinclair mini-pigs were subjected to excision of the posterior 50% of anal sphincter muscle and left to recover for 6weeks. They were randomly allocated to receive either saline treatment (Saline 1ml, n=5), 1 injection of SDF-1 plasmid 2mg/ml (1 SDF-1, n=9) or 2 injections of SDF-1, 2mg/ml each at 2weeks intervals (2 SDF-1, n=5). Euthanasia occurred 8weeks after the last treatment. In vivo outcomes included anal resting pressures done under anesthesia pre-injury, pre-injection and before euthanasia (8weeks after treatment). Anal ultrasound was done pre injury and pre-euthanasia. Tissues were saved for histology and analyzed quantitatively. Two way ANOVA followed by Holm-Sidak test and one way ANOVA followed by the Tukey test were used for data analysis, p<0.05 was regarded as significant. Posterior anal pressures at the 3 time points were not significantly different in the saline group. In contrast, post-treatment pressures in the 1 SDF-1 group pressures were significantly higher than both pre-injury (p=0.001) and pre-treatment time points (p=0.003). At the post-treatment time point, both 1 SDF-1 (p=0.01) and 2 SDF-1 (p=0.01) groups had significantly higher mean pressures compared to the saline group. Histology showed distortion of normal anatomy with patchy regeneration in the control group while muscle was more organized in both treatment groups. Eight weeks after a single or two doses of SDF-1injected into a chronic anal sphincter injury improved resting anal pressures and regenerated muscle in the entire defect. SDF-1 plasmid is effective in treating chronic defects of the anal sphincter in a large animal and could be clinically translated.

Where Is the Vagina? A Rectal Stricture after a Presumed Cloacal Repair Turns Out to be the Mobilized Vagina and a Missed High Rectovaginal Fistula

We present a case of a rare complication in a 10-month-old female referred to our institution for an anal stricture after primary cloacal repair as an infant. Multimodal imaging, careful physical exam, and endoscopic evaluation revealed her vagina had been pulled through to the location of her anal sphincter muscle complex. We describe the correction of this problem, including identification of her rectum.

Differences in fatigability of muscles involved in fecal continence: Potential clinical ramifications.

IntroductionFatigue of the anal sphincter complex has been demonstrated using high‐resolution anorectal manometry (HRAM). However, the fatigability of individual muscles such as the external anal sphincter (EAS) and puborectalis muscles (PRM) has not been described. Vaginal manometry has been used to study contractile activity of the PRM. By applying both modalities, we attempted to differentiate the fatigability between the PRM and the EAS under different exercise conditions.MethodsWe studied two groups: group 1, 12 healthy women (21 ± 2.7 years) with HRAM and group 2, 10 healthy (20 ± 3 years) women with vaginal manometry. All subjects performed 40 repetitive contractions with and without an intra‐anal resistive load. In group 1, areas under the curve (AUC) of the anal canal high‐pressure zone (HPZ) including the caudal and rostral halves were compared. In group 2, the maximum and mean pressures of the vaginal HPZ were compared.ResultsThe AUC decreased significantly only after repetitive contractions against a resistive load (462 ± 129 vs. 390 ± 131 mmHg‐cm, p = 0.02), indicating fatigue. The caudal half (EAS) decreased significantly after contractions against a load (288 ± 75 vs. 239 ± 82 mmHg‐cm, p = 0.02), while the rostral half (PRM) did not. The vaginal pressures (PRM) also decreased only after repetitive contractions against a load (maximum pressures, 358 ± 171 vs. 239 ± 109 mmHg, p = 0.02).ConclusionsThe EAS and PRM both exhibit fatigue with contractions only against a resistive load. These findings may guide the development of appropriate exercise regimens to target specific muscles involved in fecal continence.

Obstetric Perineal Tears in Pregnant Adolescents and the Influencing Factors

The incidence and risk factors of obstetric perineal tear occurrence in vaginal delivery of adolescent pregnant patients are not well established. We aimed to describe the incidence of obstetric perineal tears in adolescents and the maternal obstetric risk factors associated with this situation. Retrospective cohort study SETTING: Department of Obstetrics and Gynecology, Tepecik Education and Research Hospital, Izmir, Turkey PARTICIPANTS: Adolescent pregnant patients (≤19 years) who delivered vaginally in our institution between January 2014 and January 2021 INTERVENTIONS AND MAIN OUTCOME MEASURES: The main outcome measures were the incidence of perineal tears, the degree of perineal tears, and the risk factors associated with severe perineal tears in adolescents. Severe perineal tears include third- and fourth-degree lacerations. A third-degree tear is defined as partial or complete disruption of the anal sphincter muscles, and a fourth-degree tear is defined as lacerations involving the rectal mucosa. A total of 3441 adolescents who had a vaginal delivery were included in the study. The rate of severe perineal tear was 5.8% (200/3441). Risk factors associated with obstetric laceration in adolescents in multivariate analysis were nulliparity (OR=1.72; 95% CI, 1.14-2.41; P=0.007), high birth weight (OR=4.1; 95% CI, 2.71-6.21; P < 0.001), and labor induction (OR=1.36; 95% CI, 1.01-1.85; P=0.02). Spontaneous onset of labor and previous delivery reduced the risk of severe perineal tear in adolescent pregnant patients (respectively, OR=0.68; 95% CI, 0.51-0.94; P=0.02 and OR=0.51; 95% CI, 0.33-0.79; P=0.007). In adolescents, the risk of severe perineal tear was associated with nulliparity, birth weight, and labor induction. The only possible modifiable risk factor was labor induction.

Outcome of Bilateral Segmental Internal Anal Sphincterotomy for Treatment of Chronic Anal Fissure

Background: Chronic anal fissures are harder to treat, and surgery may be the best option. The goal of surgery is to help the anal sphincter muscles relax which reduces pain and spasms, allowing the fissure to heal. Objective: The aim of the present study was to assess the improving outcome of patients of chronic anal fissure. Patients and methods: This study included 18 patients with chronic anal fissure admitted at Department of General Surgery, Faculty of Medicine, Zagazig University. All patients were subjected to full history taking, proper local examination and baseline investigations. Anorectal manometry was performed for all patients preoperatively and bilateral segmental internal sphincterotomy was done for all patients. Results: The present study showed that 88.9% had constipation, 100.0% had pain and 77.8% had bleeding defecation. Duration was distributed as 7.55 ±2.68 with minimum 4 and maximum 14 months and the majority were between 6-12 months. Complete healing was distributed as 5.16 ±1.09 with maximum 8 weeks. Visual Analogue Scale (VAS) significantly decreased from pre to 1st 24 hours tell the end of follow up . Incontinence score significantly decreased from pre to 1st week tell the end of follow up. Conclusion: It could be concluded that bilateral segmental internal sphincterotomy takes some extra time for the procedure and significantly a good procedure in treatment of chronic anal fissures in terms of early pain relief, reduction of resting anal pressure and complete healing rate in 5 weeks. The risks of incontinence and recurrence of fissure are negligible with superior patients’ satisfaction.

Relation between pelvic floor neurophysiological abnormalities and erectile dysfunction in patients with obstructed defecation

BackgroundObstructed defecation is a common pelvic floor medical problem among adult population. Pelvic floor disorders were reported to be associated with sexual dysfunction including erectile dysfunction among male patients. The aim was to determine the relation between pelvic floor neurophysiological abnormalities and erectile dysfunction in male patients with obstructed defecation.MethodsThis cross-sectional study included 65 married male patients with obstructed defecation and a control group consisted of 15 apparently healthy married males. Assessment of obstructed defecation severity was done by using modified obstructed defecation score, time of toileting and Patient Assessment of Constipation-Quality of Life questionnaire. Assessment of erectile functions was done using erectile function domain of International Index of Erectile Function questionnaire and Erectile Dysfunction-Effect on Quality of Life Questionnaire. Anal manometry and dynamic pelvis magnetic resonance imaging were done. Electrophysiological studies included pudendal nerve motor conduction study and needle electromyography of external anal sphincter, puborectalis and bulbocavernosus muscles.ResultsThere were 32 patients (49.2%) who had erectile dysfunction. The maximum straining anal pressure was significantly higher among patients with erectile dysfunction. Pudendal nerve terminal motor latency was significantly delayed and the percentage of bilateral pudendal neuropathy was significantly higher among patients with erectile dysfunction. The percentage of electromyography evidence of denervation with chronic reinnervation in the external anal sphincter and bulbocavernosus muscles were significantly higher among patients with erectile dysfunction. Regression analysis detected three co-variables to be associated with significantly increasing the likelihood of development of erectile dysfunction. These were maximum straining anal pressure (odd ratio = 1.122), right pudendal nerve terminal motor latency (odd ratio = 3.755) and left pudendal nerve terminal motor latency (odd ratio = 3.770).ConclusionsErectile dysfunction is prevalent among patients with obstructed defecation. It is associated with characteristic pelvic floor electrophysiological abnormalities. Pelvic floor neurophysiological changes vary from minimal to severe neuromuscular abnormalities that usually accompanying erectile dysfunction. Pudendal neuropathy and increased maximum straining anal pressure are essential risk factors for increasing the likelihood of development of erectile dysfunction in patients with obstructed defecation.

Fistula in Ano-An Entity with Enigmas: what to do and what not to do

Background: Fistula-in-ano is the leading complication of perineal sepsis. Usually, a fistula has an external opening, a track, and an internal opening. Following infection and/or an abscess,External opening may appear acutely or with delayed appearance in a chronic manner. Management protocol for a fistula includesassessment of the extent of fistulous track &amp;its relation to the anal sphincter muscle, control of infection,and finally, surgical treatment of the fistula &amp; follow up. The principles in management of anal fistula aredrainage of infection or necrotic tissue, closure of internal opening of fistula tract, and removal of fistulous tract with preservation of sphincter function. The objectives of the studyis to compare the per operative and post-operative complications, mean hospital stay in the treatment of fistula in ano with treatment options like fistulotomy, fistulectomy, and setons. Methods: This is a comparative, prospective study of 60 patients who presented with their complaints to the Surgerical Outpatient department and who were admitted under the Department of General Surgery, P K Das Institute of Medical Sciences, Vaniamkulum, Palakkad, Kerala. Patients who met the inclusion criteria were included in this clinical study. Of the 60 patients selected for the sudy, 20 patients were surgically treated by fistulectomy, 20 by seton, 20 by fistulotomy over a period of 2 years. Results: Most common age of presentation is 21-30 years and more common in males then females (M:F= 2.3:1 ). Most common per operative complication was bleeding which was seen more in patients undergoing fistulectomy. 36% of the patients wound healed in less than 1 week, 22% of patients wound healed in 1 to 2 weeks,15% of patients wound healed in 2 to 3 weeks, 9% of the patients wound healed in 3 to 4 weeks. Conclusion: Fistula in ano is cured by various methods of surgery and higher antibiotics, local antibiotics with good post-operative wound management, like sitz bath without closing the wound and frequent/regular follow up.Seton technique is better compare to fistulectomy and which is better than fistulotomy.

Do resistance exercises during biofeedback therapy enhance the anal sphincter and pelvic floor muscles in anal incontinence?

To determine if a biofeedback therapy that includes concentric resistance exercise for the anal sphincter muscles can improve muscle strength/function and improve AI symptoms compared to the traditional/non-resistance biofeedback therapy. Biofeedback therapy is the current gold standard treatment for patients with anal incontinence (AI). Lack of resistance exercise biofeedback programs is a limitation in current practice. Thirty-three women with AI (mean age 60years) were randomly assigned to concentric (resistance) or isometric (non-resistance) biofeedback training. Concentric training utilized the Functional Luminal Imaging Probe to provide progressive resistance exercises based on the patient's ability to collapse the anal canal lumen. Isometric training utilized a non-collapsible 10mm diameter probe. Both groups performed a biofeedback protocol once per week in the clinic for 12weeks and at home daily. High definition anal manometry was used to assess anal sphincter strength; symptoms were measured using FISI and UDI-6. 3D transperineal ultrasound imaging was used to assess the anal sphincter muscle integrity. Concentric and isometric groups improved FISI and UDI-6 scores to a similar degree. Both the concentric and isometric groups showed small improvement in the anal high-pressure zone; however, there was no difference between the two groups. Ultrasound image analysis revealed significant damage to the anal sphincter muscles in both patient groups. Concentric resistance biofeedback training did not improve the anal sphincter muscle function or AI symptoms beyond traditional biofeedback training. Anal sphincter muscle damage may be an important factor that limits the success of biofeedback training.

Minimally invasive surgery of faecal incontinence with autologous fat injection in children

BACKGROUND: Faecal incontinence as a result of chronic functional constipation is a common problem among children. This condition is socially unacceptable. There is no clear consensus of a universally accepted pathogenesis, diagnostics, and optimal treatment for this condition. New methods of surgical treatment are necessary for accelerated normalization of the retaining faeces process and resolution of faecal incontinence in children.&#x0D; THE AIM: The study was aimed to analyze the efficiency of the new minimally invasive surgery method of the anal sphincter complex restoring with autologous fat injection in children.&#x0D; MATERIALS AND METHODS: The examined group included 31 patients aged from 4 to 17. The patients had chronic constipation combined with faecal incontinence more than once per week. All of them had no lesions of the anal sphincter and pelvic floor muscles. All patients underwent outpatient and inpatient treatment from 2016 to 2019. Patients underwent computed tomographic colonography with virtual colonoscopy in addition to general clinical methods, ultrasound and irrigoscopy. Minimally invasive surgery with autologous fat injection was performed to correct anorectal angle in the following conditions: ineffective nonsurgical treatment for 4-6 months, lengthening of puborectalis muscles, increasing of the anorectal angle more than 100 degrees.&#x0D; RESULTS: We analyzed the complaints of the patients who underwent minimally invasive surgery. The study showed reducing of symptoms severity of chronic constipation up to complete normalization of defecation frequency after surgery (34.5%) in 3 months. The study also showed the complete absence of fecal incontinence in 3 months after this minimally invasive treatment in 83 per cent of children.&#x0D; CONCLUSION: The retrorectal injection of autologous fat leads to fast resolution of faecal incontinence, normalization of defecation frequency and improvement of the life quality as a result.

Is pelvic floor muscle contractility an important factor in anal incontinence?

Pelvic floor muscle contractility (PFMC) may contribute to anal continence. The aim of this study was to assess the association between clinical and sonographic measures of PFMC and anal incontinence (AI) symptoms, after controlling for anal sphincter and levator ani muscle (LAM) trauma. This was a retrospective study of 1383 women assessed at a tertiary center between 2013 and 2016. All patients underwent an interview, including the StMark's incontinence score (SMIS) in those who reported AI symptoms, a clinical examination, including assessment of PFMC using the modified Oxford scale (MOS), and four-dimensional translabial ultrasound (TLUS). Sonographic measures of PFMC, i.e. cranioventral shift of the bladder neck (BN) and reduction of anteroposterior (AP) diameter of the levator hiatus, were measured offline using ultrasound volumes obtained at rest and on maximum pelvic floor contraction. The reviewer was blinded to all clinical data. Of the 1383 patients assessed during the study period, seven were excluded due to missing imaging data, leaving 1376 for analysis. Mean age of the participating women was 55 years and mean body mass index was 29 kg/m2 . AI was reported by 221 (16.1%) women, with a mean SMIS of 11.8. Mean MOS grade was 2.3. On TLUS, mean BN cranioventral shift was 5.9 mm and mean AP diameter reduction was 8.1 mm. LAM avulsion and significant external anal sphincter (EAS) defect were diagnosed in 24.8% and 8.7% patients, respectively. On univariate analysis, sonographic measures of PFMC were not associated with AI. Lower MOS grade was associated with symptoms of AI; however, statistical significance was lost on multivariate analysis. Clinical and sonographic measures of PFMC were not significantly associated with AI symptoms after controlling for EAS and LAM trauma. © 2020 International Society of Ultrasound in Obstetrics and Gynecology.

Proktoginekologia – kto powinien leczyć? Propozycja algorytmu postępowania

Proctogyneacology deals with conditions involving the anal canal, anal sphincter muscles, rectum, rectovaginal septum, and the female reproductive tract. They may be due to sagging of the pelvic floor and the rectovaginal septum (rectal, vaginal or uterine prolapse, enterocele and rectocele), perinatal injury, including sphincter damage, rectovaginal fistulas, endometriosis with anal sphincter and rectovaginal septum involvement, proctological inflammatory diseases in pregnancy, as well as radiation-induced rectal damage after gynaecological cancer treatment. There are no set guidelines defining which specialist should operate on these patients. We attempted to systematise this issue in the form of an algorithm. An interdisciplinary dialogue allowing for our professional development and, most of all, therapeutic success and reduced risk of postoperative complications, seems to be crucial.

Trans-Perineal Sonographic Findings of Anal Sphincter Muscle Complex in Imperforated Anus: Diagnostic Pitfalls

Trans-Perineal Sonographic Findings of Anal Sphincter Muscle Complex in Imperforated Anus: Diagnostic Pitfalls

Re‐Do Sphinkeeper™ procedure for treating recurrent faecal incontinence – a video vignette

The SphinKeeper™ procedure (THD SpA, Correggio, Italy) is a novel treatment designed for patients with faecal incontinence (FI). Up to 10 self-expandable prostheses are placed under ultrasound guidance into the intersphincteric groove (1). Mimicking anal sphincter muscle, the SphinKeeper™ is considered to improve FI (2).

The effect of vaginal delivery and Caesarean section on the anal Sphincter complex of Primipara based on optimized three-dimensional ultrasound image and nuclear regression Reconstruction Algorithm.

Objective:The study used the optimized nuclear regression reconstruction algorithm to explore the value of three-dimensional perineal ultrasound evaluation of the effect of caesarean delivery and caesarean section on the anal sphincter complex of primipara.Methods:This study performed three-dimensional perineal ultrasound scanning of the anal sphincter complex of 157 primiparas 42 days after delivery. Among them, 77 were in caesarean delivery (spontaneous delivery group) and 80 were in caesarean section (caesarean delivery group) from September 2018 to December 2020 in our hospital. The thickness of the end plane, the middle plane, the distal plane and the distal plane of the external anal sphincter at 3, 6, 9, 12 o’clock direction, and measure the thickness of the central plane of the pubic rectum muscle at 4, 8 o’clock direction. At the same time, the study used tomography and volume contrast imaging to observe the morphology and integrity of the anal sphincter complex.Results:The thickness of the distal anal sphincter at the 12 o’clock direction, the proximal anal sphincter at 6, 12 o’clock, and the central plane at 9 and 12 o’clock in the obstetric group were smaller than those in the caesarean section group (all P < 0.05). There were no significant differences in the thickness of the remaining anal internal and external anal sphincter and puborectalis muscles between the two groups in different directions (all P> 0.05). In the obstetric group, a perineal sphincter defect was found via three-dimensional perineal ultrasound.Conclusion:The delivery method has a certain influence on the shape of the anal sphincter complex. The thickness of the internal and external anal sphincter of the primiparous women in a certain direction is significantly smaller than that of caesarean section. Transperineally three-dimensional ultrasound can clearly show the morphological characteristics and integrity of the anal sphincter complex, and diagnose the defect of the anal sphincter complex.

Evaluation of the Mechanical Properties of Anorectal Tissues and Muscles by Shear Wave Elastography in Anal Fıssure Disease.

To evaluate the mechanical properties of the tissues and muscles in the anal region with the shearwave elastography for anal fissure etiology. Descriptive study. Adana City Training and Research Hospital, Turkey, from March2019 to March 2020. In this study, 30 patients (fissure group), who were diagnosed with anal fissure in the outpatient clinic; and 20 patients (control group), who did not have any problem in anal examination were included. The anorectal tissues and muscles mechanical properties(elasticity,compliance and stiffness) were compared with the shear wave elastography values.Fissure area,internal anal sphincter,external anal sphincter and levator ani muscles elastographic measurements was performed with 5-18 MHzin lithotomy position, at rest and with Valsalva maneuver. In elastographic measurement of fissure area (fissure) and normal anorectal tissue (control, AFE); control group values were significantly higher than the fissure group values (p<0.001, and padj <0.001, respectively). Control group valuesof internal anal sphincter in rest and Valsalva maneuver (IAS-R, and IAS-V, respectively) were significantly higher than the fissure group values (p<0.001, padj< 0.001, and p<0.001, padj <0.001, respectively). There was no significant difference between the elastographic measurement values in rest and valsalva maneuver of the external anal sphincter (EAS-R and EAS-V) (p>0.05). Elastographic measurement values of levator ani muscle (LAM) resting state; were significantly higher in thefissure group than the control group (p<0.001, and padj <0.001, respectively). Elastographic cut-off values that differentiate the fissure group from control group were found to be ≤1kPa forAFE group, ≤44 kPa forIAS-R, ≤0.4kPa forIAS-V,and >11kPa for LAM,respectively. Conclusıon: In anal fissure disease, tissues mechanical properties measured by shear wave elastography showed increased tissue stiffness, which may be added to etiology of this disease. Key Words: Anal fissure, Ultrasonography, Shear wave elastography, Anal sphincter, Tissue elasticity, Tissue stiffness.

The Japanese Extracted Herbal Medicine Daikenchuto Increases the Contractile Activity of the Internal Anal Sphincter Muscle in Conscious Dogs.

Objectives: This study aimed to elucidate the effect of the extract of daikenchuto (DKT), a Japanese Kampo medicine, on the contractile activity of the internal anal sphincter in conscious dogs. Methods: Force transducers were attached to the serosal surface of the rectum and the internal anal sphincter of male beagle dogs. In addition, the contractile activity of the rectum and the internal anal sphincter was continuously measured until 6 h after DKT administration via telemetry in the conscious state. The DKT dose was 1.5 g/body, and the administration route was intrarectal in the expectation of a direct effect on the rectoanal region. DKT was re-administered to the same animal after drug withdrawal, and the plasma concentrations of hydroxy-α-sanshool (HAS) and hydroxy-β-sanshool (HBS) before and after administration were measured. Results: After DKT administration, the contractile activity of the internal anal sphincter immediately increased, peaked at 10 min, continued for ≥1 h, and had almost disappeared after 4 h. Rectal contraction differed from that of the internal anal sphincter, with no significant contraction observed. HAS and HBS were found in the plasma of animals administered with DKT and persisted up to 2 h after the administration. Conclusions: This is the first report on in vivo telemetry demonstrating that DKT exhibited contractile effects on the dog's internal anal sphincter. The increased anal pressure and improvement of fecal incontinence symptoms observed in previous clinical studies may have been based on this sphincter contraction.

Physiotherapy for Prevention and Treatment of Fecal Incontinence in Women-Systematic Review of Methods.

Fecal incontinence (FI) affects approximately 0.25–6% of the population, both men and women. The most common causes of FI are damage to/weakness of the anal sphincter muscle and/or pelvic floor muscles, as well as neurological changes in the central or peripheral nervous system. The purpose of this study is to report the results of a systematic review of the possibilities and effectiveness of physiotherapy techniques for the prevention and treatment of FI in women. For this purpose, the PubMed, Embase, and Web of Science databases were searched for 2000–2020. A total of 22 publications qualified for detailed analysis. The studies showed that biofeedback (BF), anal sphincter muscle exercises, pelvic floor muscle training (PFMT), and electrostimulation (ES) are effective in relieving FI symptoms, as reflected in the International Continence Society recommendations (BF: level A; PFMT and ES: level B). Research has confirmed that physiotherapy, by improving muscle strength, endurance, and anal sensation, is beneficial in the prevention of FI, both as an independent method of conservative treatment or in pre/post-surgery treatment. Moreover, it can significantly improve the quality of life of patients. In conclusion, physiotherapy (in particular, BF, PFMT, or ES, as effective methods) should be one of the key elements in the comprehensive therapy of patients with FI.

Biofeedback for Pelvic Floor Disorders.

Defecatory disorders can include structural, neurological, and functional disorders in addition to concomitant symptoms of fecal incontinence, functional anorectal pain, and pelvic floor dyssynergia. These disorders greatly affect quality of life and healthcare costs. Treatment for pelvic floor disorders can include medications, botulinum toxin, surgery, physical therapy, and biofeedback. Pelvic floor muscle training for pelvic floor disorders aims to enhance strength, speed, and/or endurance or coordination of voluntary anal sphincter and pelvic floor muscle contractions. Biofeedback therapy builds on physical therapy by incorporating the use of equipment to record or amplify activities of the body and feed the information back to the patients. Biofeedback has demonstrated efficacy in the treatment of chronic constipation with dyssynergic defecation, fecal incontinence, and low anterior resection syndrome. Evidence for the use of biofeedback in levator ani syndrome is conflicting. In comparing biofeedback to pelvic floor muscle training alone, studies suggest that biofeedback is superior therapy.

The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Management of Rectal Cancer.

The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Management of Rectal Cancer.

Use of bilateral superficial gluteal muscle flaps for the repair of ventral perineal hernia in dogs: A cadaveric study and short case series.

To describe bilateral mobilization of the superficial gluteal muscle (SGM) to treat ventral perineal hernias in dogs. Cadaveric study and short case series. Male dog cadavers (n = 10) weighing between 5 and 42 kg and three dogs treated for ventral perineal hernia. Cadavers were positioned in right and left lateral recumbency to free the origin and insertion of the ipsilateral SGM except for muscle fibers originating on the first tail vertebra and sacrotuberous ligament. The dogs were placed in ventral recumbency to approach the perineum and rotate the muscle flaps. The insertions of the SGM were sutured together ventral to the anal sphincter muscle. The dorsal border of the overlapping tendons was sutured to the anal sphincter muscle, and the ventral border was sutured to the ischiourethralis muscle. The amount of overlap between bilateral flaps was measured. The SGM flaps were used to revise recurrent perineal hernias in three dogs. Superficial gluteal muscle flaps were created without damage to the blood supply in all dogs. The overlap between the bilateral flaps ventral to the anal sphincter measured 0 to 2.4 cm. No recurrence was detected at follow-up (6-12 months) in the three dogs treated with these flaps. Superficial gluteal muscle flaps were mobilized without damage to the blood supply and crossed the midline ventral to the anal sphincter. Flaps were used successfully to repair ventral perineal hernias in three dogs. Bilateral SGM flaps can be considered to repair ventral perineal hernias.