COMPARATIVE ASSESSMENT OF SPINCTER MUSCLE COMPLEX IN CHILDREN AFTER SURGICALCORRECTION OF ANORECTAL MALFORMATION

A comprehensive study of the state of the spincter muscle complex in children after surgical correction of anorectal malformations was carried out,including MRI of the structure of the spincter muscle complex,fecal continence on the Rintala scale, manometric studies of the anal function.The poor development of the spincter muscle complexwas characterized by a decrease (p < 0,05) of the average values of the relative width of the puborectal muscle (PRWR) to 0,14 ± 0,03, for the relative width of the external anal sphincter (EASWR) to 0,12 ± 0,02, which turned out to be 2,4 times lower than patients with excellent and good results. Values of PRWR <0,18 and EASWR <0,15 in 63 % of cases corresponded to an unsatisfactory result on the Rintala scale and was accompanied by fecal incontinence. A good function of anal function was observed in 58 % of patients with PRWR >0,18 and EASWR >0,15.

Professor Max Wilms: 150th anniversary of birth - in memoriam

The research activity of M. Wilms is characterized by diversity of its objects and breadth of breadth of its scope. A surgeon-oncologist, he is known to have devoted a number of his studies, to purely theoretical issues of Oncology. On the other hand, M. Wilms contributed to the development of clinical surgery and Oncology, offering a number of new methods of diagnostics and treatment of major forms of malignant tumors of the genital organs and kidney, making a significant contribution to the practice of world medicine. Classical studies of teratogenic tumors of the ovaries and testicles, mixed tumors, tumors of kidney belong to M. Wilms. The tumor described by M. Wilms in 1899 which is named after him is one of the most frequent malignancies in children usually occurring at the age of 2-5 years but which can also occur at any age, even in very old patients. In the same year his famous monograph “Mixed tissue tumor of the kidney” was published. In 1904 M. Wilms was awarded the title of Professor, and two years later he published his fundamental work “Intestinal obstruction – pathology and clinic” (1906), which brought M. Wilms fame and recognition among surgeons, oncologists and pathologists all over the world. M. Wilms also made contribution into pediatric surgery. In 1906 he proposed to classify the intussusception types, depending on the name of the colon which forms the intussusception head (the iliac colon, caecum, etc.). Analyzing the etiology of Hirschsprung's disease Max Wilms is known to have adhered to the theory of prolonged spasm of the anal canal and, consequently, to inception of secondary megacolon (1904). His assumptions he confirmed by performing manometric studies at the level of the anal canal of the rectum, and in the treatment he applied the method of anal bougienage. A talented scientist and teacher, demanding and fastidious towards himself and his disciples, Max Wilms published more than 130 research papers, of most of which he was the sole author.

Management of fourth degree obstetric perineal tear without colostomy using non - stimulated gracilis - our experience over eleven years

ABSTRACTBackground: Although gracilis muscle transposition for faecal incontinence has been well-described method, its literature for use in obstetric perineal tear without colostomy is sparse. In this study, we have tried to analyse its use in fourth-degree obstetric perineal tears. Patients and Methods: A total of 30 patients with recto-vaginal fistula with faecal incontinence secondary to obstetric perineal tear were retrospectively studied between February 2003 and May 2014. The recto-vaginal fistula was explored, dissected and identification of sphincters was done using muscle stimulator. Fistula closure was done followed by sphincter repair, vaginal tightening procedure and single gracilis transposition. None of the patients had covering colostomy. Faecal incontinence was assessed pre- and post-operatively by digital rectal examination (single examiner), Park's score and Corman's score in all cases and using barium hold and transperineal ultrasonography, manometric studies in a few cases. The outcome was measured at an average follow-up of 8.8 months (7–24 months). Results: As per Park's score 26 patients had Grade I continence, two had Grade II and two patients had Grade III continence. Corman's score improved from fair to excellent in 26 patients. The patients in whom manometry was performed showed a remarkable rise in both resting and squeeze pressures. Two patients developed post-operative infections in upper 1/3 thigh incision site and three patients at gluteal region scar site. Conclusion: Satisfactory continence following gracilis muscle could be achieved.