Name of the Procedure:

Sphincteroplasty, Anal, for Incontinence, Adult; Levator Muscle Imbrication (Park Posterior Anal Repair)

Summary

Sphincteroplasty is a surgical procedure aimed at repairing and strengthening the anal sphincter muscles to treat fecal incontinence. The technique known as Park Posterior Anal Repair specifically involves tightening the levator muscle to provide additional support.

Purpose

This procedure addresses fecal incontinence, a condition where individuals have difficulty controlling bowel movements. The goal is to restore muscle function and strength, allowing better control and reducing or eliminating incontinence episodes.

Indications

• Chronic fecal incontinence
• Weakness or damage to the anal sphincter muscles
• Patients who have not responded well to non-surgical treatments like biofeedback or medication

Preparation

• Fasting for at least 8 hours prior to surgery
• Adjustment of certain medications, especially blood thinners
• Preoperative assessment including physical examination and possibly imaging studies to evaluate the sphincter muscle

Procedure Description

1. Anesthesia is administered, typically general or regional.
2. An incision is made in the perineal area to access the anal sphincter.
3. The levator muscle is identified and imbricated (folded and stitched) to reinforce the sphincter.
4. The sphincter muscle is then reconstructed and tightened around the anal canal.
5. The incision is closed with sutures.

Tools and equipment include scalpels, sutures, retractors, and sometimes specialized laparoscopic instruments.

Duration

The procedure typically takes about 1-2 hours.

Setting

This surgery is usually performed in a hospital or a surgical center equipped with the necessary operating room equipment.

Personnel

• Surgeons specializing in colorectal or general surgery
• Anesthesiologists
• Surgical nurses and technicians

Risks and Complications

• Infection
• Bleeding
• Pain at the surgical site
• Anesthetic risks
• Recurrence of incontinence
• Possible damage to nearby nerves or tissues

Benefits

• Improved control over bowel movements
• Reduction or elimination of incontinence
• Improved quality of life and confidence

Recovery

• Hospital stay of 1-2 days post-surgery
• Instructions to avoid heavy lifting or straining for several weeks
• Pain management with prescribed medications
• Follow-up appointments to monitor healing and function
• Possible temporary dietary adjustments to ease bowel movements

Alternatives

• Pelvic floor physical therapy
• Biofeedback therapy
• Sacral nerve stimulation (SNS)
• Medications to firm stool and reduce incontinence episodes
• Use of absorbent pads or anal plugs

Pros and cons include varying degrees of effectiveness, invasiveness, and long-term outcomes. Sphincteroplasty is generally considered when non-surgical options are insufficient.

Patient Experience

During the procedure, the patient will be under anesthesia and will not feel any discomfort. Postoperatively, there may be pain and discomfort at the incision site, managed with pain relief medications. Some may experience temporary bowel irregularities, and support measures such as sitz baths can be advised for comfort.