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In fecal incontinence (FI), surgery may be carried out if conservative measures alone are not sufficient to control symptoms. There are many surgical options described for FI, and they can be considered in 4 general groups. Much research has been conducted on the many surgical options, and their relative effectiveness is debated. Due to the lack of good quality evidence, it is impossible to identify or refute clinically important differences between the alternative surgical procedures. The "optimal treatment regime may be a complex combination of various surgical and non-surgical therapies. * Restoration and improvement of residual sphincter function :::: * sphincteroplasty (sphincter repair) :::: * Correction of anorectal deformities that may be contributing to FI :::: * Sacral nerve stimulation * Replacement / imitation of the sphincter or its function :: * ''Narrowing of anal canal to increase the outlet resistance without any dynamic component'' :::: * Anal encirclement (Thiersch procedure) :::: * Radiofrequency ablation ("Secca procedure") :::: * Nondynamic graciloplasty ("bio-Thiersch") :::: * Implantation/injection of microballoons, carbon-coated beads, autologous fat, silicone, collagen. :: * ''Dynamic sphincter replacement'' :::: * Implantation of artificial bowel sphincter (neosphincter) :::: * Dynamic graciloplasty * Antegrade continence enema (ACE)/ antegrade colonic irrigation * Fecal diversion (stoma creation) A surgical treatment algorithm has been proposed for FI, although this did not appear to include some surgical options. Isolated sphincter defects may be initially treated with sphincteroplasty and if this fails, the patient can be assessed for sacral nerve stimulation. Functional deficits of the external anal sphincter (EAS) and/or internal anal sphincter (IAS), i.e. where there is no structural defect, or only limited EAS structural defect, or with neurogenic incontinence, may be assessed for sacral nerve stimulation. If this fails, neosphincter with either dynamic graciloplasty or artificial anal sphincter may be indicated. Substantial muscular and/or neural defects may be treated with neosphincter initially. ==Sphincteroplasty (sphincter repair)== This operation aims to repair sphincter defects (which may be of unknown cause) or damage from trauma (usually caused by obstetric damage). Where the sphincter has separated from a tear, this procedure brings these ends back together. Primary sphincteroplasty is repair carried out soon after the trauma has occurred, whilst other repairs may be carried out years after the original trauma (secondary or delayed sphincter repair), usually because the trauma went unrecognised. Usually, sphincter defects are in the anterior position on the sphincter, when an anterior sphincteroplasty may be carried out. Where the sphincter defect is laterally or posteriorly placed, this carries a less successful outcome.〔 Overlapping anterior sphincteroplasty is preceded by a bowel preparation and possibly antibiotics. Once the patient is under anesthesia, an incsion is made in front of the anus (the anterior perineum). Scar tissue is removed and the mucosa of the anal canal separated from the damaged sphincter. The sphincter is cut and its ends overlapped and then stitched back together. The exact method of the procedure varies, e.g. the cut sphincter may be stitched back end to end, rather than overlapped, or the IAS and EAS may be repaired as separate stages. Sphincter repair may sometimes be combined with an anterior levatorplasty (an operation to tighten the pelvic floor). A surgical drain is left to prevent buildup of fluid. After the operation, sitz baths are recommended to maintain hgygeine during healing, and laxatives prescribed to avoid hard stool.〔 Overlapping anterior sphincteroplasty improves FI symptoms in the short term in most (50-80%) patients with sphincter defects. Thereafter, continence deteriorates. Most who undergo this operation are incontinence again after 5 years. Poor results with this procedure may be related to pelvic floor denervation (nerve damage). Primary sphincter repair is inadequate in most women with obstetric ruptures following vaginal delivery. Residual sphincter defects remain in most and around 50% remain incontinent. Residual sphincter defect following the operation (as demonstrated by endoanal ultrasonography) then the procedure may be repeated.〔〔 抄文引用元・出典: フリー百科事典『 ウィキペディア（Wikipedia）』 ■ウィキペディアで「Surgical management of fecal incontinence」の詳細全文を読む スポンサード リンク
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