By Charles V. Mann MCh, FRCS, Richard E. Glass MS, FRCS (auth.)

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Since sepsis is the main cause whereby a technically satisfactory operation can be destroyed, every precaution should be taken to minimise bacterial contamination of the wound by: 1. 2. 3. 4. 5. Pre-operative bowel preparation Perfect haemostasis An indwelling suction drain Per-operative antibiotic cover by gentamicin and metronidazole Meticulous surgical technique The repair should be protected postoperatively against faecal disruption, and if necessary the bowels should be confined and a low (or nil) residue diet given until sound healing has taken place.

Fig. 13. Wh en posterior mobili ation of the rectum is comple te the rectum can be elevated and traightened by gentle traction over the finger. The pro thetic sling is placcd around the front of the rectum while it is held in an elevated po ition. 34 SURGICAL TREATMENT OF AN AL INCONTIN ENCE Fig. 16. The sling should not be drawn tight across the front of the rectum. A practical guide is that there should be space enough to insert the tip of the index finger between the sling and the rectum. Fig.

The operation aims to: 1. 2. 3. 4. 5. 6. Preparation The majority of patients with complete rectal prolapse are elderly and require pre-operative 21 7. 8. Elevate, straighten and refasten the prolapsed rectum in the pelvis Prevent intussusception of the rectal wall Promote adhesions between the back of the rectum and front of the sacrum Tether the back of the upper and middle parts of the rectum to the front of the sacral promontory Remove the excessively deep anterior peritoneal pouch Strengthen the recto-vaginal septum and obliterate the deep recto-vaginal peritoneal pouch Ventrosuspend the uterus (if present) Restore the peritoneal floor at the level of the pelvic brim 22 SU RGICAL TREATMENT OF AN AL INCONTINENCE Fig.

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