PFD Week 2017-Autologous Fascia Lata Spiral Sling Anal Sphincteroplasty: Salvage Repair for Fecal Incontinence

Video Transcription

This video describes the autologous fasciolata spiral sling anal sphinctroplasty. With the patient in lithotomy position, attention is paid to the anal region.  The anal canal is examined and noted to be incompetent, with absence of sphincter tone and allowing for the easy passage of one to two digits on exam.  A Scott-style self-retaining retractor is applied and four sites are marked at the 12, 3, 6, and 9 o'clock positions around the anus.  Each is approximately two centimeters long and at least one centimeter from the anal opening.  We start with a lateral incision and electrocauterize the underlying subcutaneous perirectal fat. Curved mayo scissors are used to further dissect the space.  The same is done on the contralateral side. Finger dissection may also aid in the creation of a circumferential tunnel in the perirectal space around the anal sphincter.  Dissection is performed in the same manner at the 12 and 6 o'clock positions.  Large clamps are separated to create space for the fascial sling. We now transfer the sling on one side from the inferior incision to the lateral incision  and from the lateral incision to the superior incision. The same is performed on the other side with the opposite end of the graft,  from the inferior incision to the lateral and from the lateral incision to the superior incision.  The free ends of the fascial sling are crossed over and gently placed on traction. Retractor skin hooks are applied to the perianal skin.  To tension the graft, we place a finger in the rectum and place gentle traction on the sutures. The surgeon should be able to pass a finger snugly into the anal canal.  Once you have determined the appropriate degree of desired coaptation, place two delayed absorbable sutures through the intersection where the graft ends cross and secure.  We have found that this provides adequate coaptation without undue tension. We then close the wound in two layers and apply a skin adhesive.  This completes the surgical technique for the autologous fasciolata spiral sling anal sphingroplasty.

Video Summary

This video demonstrates the autologous fasciolata spiral sling anal sphinctroplasty procedure. The patient is in lithotomy position, and the anal canal is found to be incompetent. Four incisions are made at the 12, 3, 6, and 9 o'clock positions around the anus. Dissection is performed to create a tunnel in the perirectal space. Large clamps are used to create space for the fascial sling. The sling is transferred from one incision to another, and the same is done on the other side. The free ends of the sling are crossed over and traction is applied. Sutures are placed to secure the graft ends, and the wound is closed in two layers.

Asset Subtitle

My-Linh (Mimi) Nguyen, MD

Keywords

autologous fasciolata spiral sling anal sphinctroplasty procedure

lithotomy position

incompetent anal canal

perirectal space

fascial sling