By Laurence R. Sands, Dana R. Sands
A nice single-source reference encompassing all points of colorectal surgical procedure, Ambulatory Colorectal Surgery covers topics:
- patient evaluation
- anorectal anatomy
- anorectal ultrasound
- biofeedback techniques
- fecal incontinence review and management
- wound management
- stoma management
- pain management
- anal fissure
- anorectal abscess
- proctalgia fugax
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Additional info for Ambulatory Colorectal Surgery
The relatively inaccurate recordings as a result of electrical interference from the other adjacent muscles as well as the difficulty in assessment of surface electrodes prompted the development of disposable anal plug electrodes (Fig. 6) (50). These are plastic or sponge plugs that consist of two longitudinal or circular electrodes mounted on their surfaces. The former is considered superior since longitudinal electrodes correlate better with fine-wire electrodes (44,51). Although surface plugs can be easily inserted inside the anal canal and hence are much more tolerable by the patients, they provide only generalized information about the sphincter.
At that time, a string galvanometer was used to detect the electrical activity. In 1929, Adrian and Bronck devised the concentric needle electrode, which was followed by successful recording of anal sphincter electromyography (EMG) by Beck in 1930. Since that time, anal EMG was further developed and widely used to assess the functional activity of the pelvic floor (44). Anal EMG entails observing and recording the electrical activity from the striated muscle fibers constituting the EAS and puborectalis muscles at rest and during voluntary contraction, simulated defecation, and various reflexes.
The parasympathetic supply derives from S2, S3, and S4. These fibers emerge through the sacral foramen and are called the nervi erigenti. They pass laterally, forwards, and upwards to join the sympathetic hypogastric nerves at the pelvic plexus. From the pelvic plexus, combined postganglionic parasympathetic and sympathetic fibers are distributed to the upper rectum and left colon, via inferior mesenteric plexus, and to the lower rectum and upper anal canal. The periprostatic plexus, a subdivision of the pelvic plexus situated on the Denonvilliers’fascia, supplies the prostate, seminal vesicles, corpora cavernosa, vas deferens, urethra, ejaculatory ducts, and bulbourethral glands.