부산대학교 도서관

INTRODUCTION Most anal sphincter injuries are obstetric and iatrogenic. Sphincter damage identified in postpartum ultrasonographic examinations occurs in 30% of women after first vaginal delivery (1). A study of sphincter [...]
Objective: Sphincteroplasty is of great importance in the repair of anal sphincter damage. In the present study, we compared the results of overlapping sphincteroplasty and direct apposition techniques used in anal sphincter repair. Material and Methods: Between 2011 and 2021,36 patients underwent sphincteroplasty for anal sphincter injury and were analysed retrospectively. Sex, age, etiologic factors, repair technique, degree of laceration, postoperative complications, length of hospital stay, time between injury and repair, follow-up time and postoperative Cleveland Clinic Incontinence Score (CCIS) were recorded for analysis, and the two techniques were compared statistically using SPSS statistics, Version 17.0. Results: Of the sample, 31 were females and five were males, with a mean age of 31.50 [+ or -] 6.7 years. The etiologic factors were obstetric trauma in 25 patients, perianal interventions in seven patients and other traumas in four patients. The overlapping technique was applied to 14 patients and the direct apposition technique was applied to 22 patients. Mean postoperative CCIS of all cases was 5.53 [+ or -] 2.59, and was significantly lower in those who underwent overlapping sphincteroplasty technique than those who underwent apposition repair (p= 0.006). It was observed that postoperative CCIS decreased as the time between sphincter injury and repair decreased (p< 0.001; r= 0.625). Conclusion: It is vital to repair anal sphincter damage as early as possible. The overlapping sphincteroplasty and direct apposition methods can both be considered safe for anal sphincter repair although in terms of faecal incontinence, the outcomes of overlapping sphincteroplasty are better than those of the direct apposition technique. Keywords: Anal sphincter injury, direct apposition, fecal incontinence, overlapping sphincteroplasty Giris ve Amaç: Anal sfnkter hasarinin onariminda sfnkteroplasti büyük önem tasimaktadir. Bu çalismada anal sfnkter onariminda kullanilan örtüsen sfnkteroplasti ve direkt apozisyon tekniklerinin sonuçlarini degerlendirmeyi amaçladik. Gereç ve Yöntem: 2011-2021 yillari arasinda anal sfnkter yaralanmasi nedeniyle sfnkteroplasti uygulanan 36 hasta retrospektif olarak analiz edildi. Yas, cinsiyet, etyolojik faktör, laserasyon derecesi, onarim teknigi, postoperatif komplikasyonlar, yaralanma ile onarim arasinda geçen süre, hastanede yatis süresi, takip süresi, postoperatif Cleveland Klinigi Inkontinans Skoru (CKIS) degerlendirildi. Iki teknik SPSS versiyon 17,0 ile istatistiksel olarak karsilastirildi. Bulgular: Hastalarin 31'i kadin, besi erkekti ve yas ortalamasi 31,50 [+ or -] 6,7 yil idi. Yirmi bes hastada obstetrik travma, yedi hastada perianal girisim, diger dört hastada ise travma etyolojik faktördü. Overlapping teknigi 14 hastaya, direk apozisyon teknigi ise 22 hastaya uygulanmisti. Tüm olgularin ortalama postoperatif CKIS 5,53 [+ or -] 2,59 idi. Overlapping sfnkteroplastide CKIS, apozisyon onarimina göre anlamli ölçüde daha düsüktü (p= 0,006). Sfnkter hasari ile onarim arasinda geçen süre azaldikça postoperatif CKIS'nin de düstügü gözlendi (p< 0,001; r= 0,625). Sonuç: Anal sfnkter yaralanmalarini erken dönemde onarmak oldukça önemlidir. Overlapping ve direk apozisyon teknikleri sfnkter onariminda güvenilir yöntemlerdir. Ayrica fekal inkontinans açisindan overlapping sfnkteroplastinin sonuçlari direk apozisyon tekniginden daha iyidir. Anahtar Kelimeler: Anal sfnkter hasari, direk apozisyon, fekal inkontinans, overlapping sfnkteroplasti