ABSTRACT
Background: Evaluating the results of surgical repair of anal sphincter injuries after anal trauma resulting from difficult vaginal childbirth, direct perineal trauma, and anal surgical interventions, and determining the best time and the best operative technique to manage these injuries. Methods: The study was performed retrospectively in Al Assad University Hospital and Al Mouassat University Hospital in Damascus between 2001 and 2008. Twenty-one patients were included in the study. We determined the causes, timing of patient referral, clinical complaints, degree of fecal incontinence, and the diagnostic studies. We searched the surgical interventions which were performed in these patients and evaluated the success rate of these operations. Results: The study included 21 patients with median age of 23; most patients [86%] were females. The causes of anal sphincter injuries varied between vaginal deliveries [43%], surgical interventions on the anal canal [14%], and perineal trauma [43%]. Two cases presented directly after the injury, and direct repair was possible. All other cases presented some time after the occurrence of the injury and they were investigated accordingly. Most patients had advanced injuries [stages 3a, 3b, and 4]. The injury was repaired only in 19 patients [90%], and two injuries [10%] could be n, t operated on due to excessive injury in the area. Recovery was complete in 15 patients [71%], partial in 3 patients [14%], and unsuccessful in one patients [5%]. Conclusion: Anal sphincter injuries are among the most devastating injuries to the patients, both psychologically and socially. Prevention is of utmost importance by avoiding traumatic interventions during vaginal deliveries. When they occur they should be assessed and repaired promptly with experienced hands. The surgical technique of choice is end-to-end repair in acute cases and overlapping sphincteroplasty in patients referred chronically, provided that the repair is performed by experienced hands with the advent of colostomy whenever necessary, especially in advanced injuries
ABSTRACT
To determine the results of laparoscopic Heller myotomy with complete or partial fundoplication for the treatment of achalasia and evaluating its longterm benefits and complications. The study was performed retrospectively and prospectively, including all patients with achalsia who where treated by laparoscopic Heller myotomy with fundoplication in Al Assad University Hospital in Damascus between 2005 and 2008. Data was collected from the files of the patients and included symptoms, diagnostic studies, previous therapeutic interventions, surgical treatment, in addition to the results and complications of therapy. Twenty one patients have undergone laparoscpic Heller myotomy with fundoplication. The average age was 32 years, and the dysphagia score was 7 points on average. The median pressure in the lower esophageal sphincter was 35 mmHg. Five patients [24%] had previous therapeutic interventions which included balloon dilatation and botox injection; all of them have suffered recurrence. Laparoscpic Heller myotomy with fundoplication was eventually performed in all patients. The antireflux procedure was Nissen fundoplication in five patients [24%] and Dor anterior fundoplication in 16 patients [76%]. Intraoperative esophageal mocusal perforation has occurred in 5 patients [24%], and one patient [5%] experienced postoperative gastroesophageal reflux. The dysphagia score has dropped to 2-3 points in all patients. No relation was seen between the degree of clinical improvement and the technique used in fundoplication. Laparoscpic Heller myotomy with Dor anterior fundoplication represents the procedure of choice for treatment of achalasia, regardless of previous therapeutic interventions. This operation will control the symptoms and prevent the gastroesophageal reflux with minimal complications
ABSTRACT
To evaluate modified technique [Delorme operation] for treatment recto urethral fistules [14] were treated with this technique from 1999 to Dec 2005; the fistule was congenital in 5 patients [35.7%], traumatic in [4] patients [28.6%], iatrogenic in 2 patients, and primary in 3 patients [21.4%]. The fistule was near dentate line in 3 patients [21.4], and above it in 11 patients [78.6%]. The fistule above verumontanum in 6 patients [42.5%], and below 8 patients [57.1%]. The operation after colostomy was done trans midline perineal incision, and rectal mucosa and sub mucosa was stripping off the muscularis layer for 1-2 cm above the fistule, then closeding the orifice, the mucosa rotated by [45] degree. The success cutting and sphincter was performed in 4 patients [28.6%] rate 100% without any recurrence, and without complications. The operation was easy to done without recurrence the fistule and without complications