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Original article by Maxwell E. Haverfield
The Northern Hospital, Epping, Victoria, AUSTRALIA.

A pilot study: The anal sphincter support procedure for the treatment of anal incontinence.

Figure 1: Anorectal Anatomy

 

Anorectal Anatomy
Figure 1: 1. External anal sphincter. 2. Transverse rectal folds; rectal ampulla. 3. Anal sinuses. 4. Skin. 5. Subcutaneous part of external anal sphincter. 6. Superficial part of external anal sphincter. 7. Deep part of external anal sphincter and pubo rectalis. 8. Semi tendinosus. 9. Gluteous maximus. 10. Ischio rectal fossa. 11. The longitudinal muscle coat. 12. Pubo coccygeous. 13. Obturator internus. 14. Iliococcygeous. 15. Pelvi-rectal space. 16. Para rectal fossa. 17. Internal circular muscle coat/ internal ano rectal sphincter.



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Figure 2: Placement of ASSP Monarc TM tape

 

Placement of ASSP Monarc TM tape
Figure 2: Placement of ASSP Monarc TM tape

1. Incision over the perineal body at the hymenal ridge to expose the perineal body.

2. Anal sphincter support prosthesis, Monarc T in situ / surrounding the superficial part of the external anal sphincter.

3. Alternative incision site for placement of the Monarc T tape.

 

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Figure 3: Position of Monarc TM and Apogee TM prosthesis when ASSP is performed together with a prolapse repair using the Apogee TM system


Position of Monarc TM and Apogee TM prosthesis
Figure 3: Position of Monarc TM and Apogee TM prosthesis when ASSP is performed together with a prolapse repair using the Apogee TM system

1. External anal sphincter.

2. Perineal body.

3. Pubo rectalis and pubo vaginalis.

4. Superficial transverse perineal muscle.

5. Anal sphincter support tape (Monarc T) in situ.

6. Posterior pelvic compartment support prosthesis (Apogee T) in situ.


 

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Figure 4

Operative technique
Figure 4: See article.

 

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Figure 5

Operative technique
Figure 5: See article.

 

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