By Laurence R. Sands, Dana R. Sands
A nice single-source reference encompassing all elements of colorectal surgical procedure, Ambulatory Colorectal Surgery covers topics:
- patient evaluation
- anorectal anatomy
- anorectal ultrasound
- biofeedback techniques
- fecal incontinence evaluate and management
- wound management
- stoma management
- pain management
- anal fissure
- anorectal abscess
- proctalgia fugax
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Additional info for Ambulatory Colorectal Surgery
Physiologic testing after a careful history and physical examination can provide the physician with the needed insight to offer the most effective treatment regimen. This chapter will present the most widely used diagnostic modalities with emphasis on their underlying principle, technique, interpretation, and clinical application. ANORECTAL MANOMETRY Background and Basic Concepts Since the classic experiments of Denny-Brown and Robertson (3) in 1935, explaining the mechanisms underlying human defecation based on a manometric study, anorectal manometry (ARM) has become widely used for studying anorectal functional disorders (3).
A larger catheter may help to avoid this problem. Technical errors may result in the false absence of RAIR. Presence of stool in the rectum may interfere with proper placement of the balloon as well as inflation of the balloon. In a patient with a megarectum, more volume is required to inflate the balloon in order to cause rectal distension and induce a reflex. A leaking balloon may not distend the rectum enough to elicit a reflex. ANORECTAL PHYSIOLOGY 27 Patients with fecal incontinence often use accessory muscles to accommodate for poor sphincter function, thus falsely elevated squeeze pressures can arise from gluteal muscle contraction (3).
The transducer transforms the pressure signals into electronic ones that are transformed and processed through an amplifier and subsequently presented as measurements (4). Instrumentation There are three basic systems used to perform ARM: Fluid or air-filled balloon systems, Water perfused systems, and Microtransducers. Fluid or Air-Filled Balloon Systems In 1965, Schuster et al. (5) described a method for measuring anal sphincter pressures. The air-filled balloon device consisted of a latex balloon was tied around a hollow cylinder, through which another balloon could be passed, thus creating two compartments.
Ambulatory Colorectal Surgery by Laurence R. Sands, Dana R. Sands