Surgical Technique and Muscle Fiber Conversion

Contrary to Baeten's technique, we and others have applied incisions anterior and posterior to the anus, which allows the possibility of doing the sometimes technically demanding dissection behind the vagina under direct sight; the blunt dissection of the lateral ischiorectal fat is rarely difficult [2, 6].

A sometimes limiting factor in this operations is the length of the gracilis muscle, and emphasis must be put on an almost complete muscular (i.e., 360°) coverage of the anus, as contact with the tendon might lead to injury and erosion of the anal canal. Adduction of the leg during the wrapping of the muscle will give additional length in this situation; however, the common sitting position during defecation with abducted legs will lead to a higher tension of the muscle and possibly anal stenosis. A possible (although not always successful) solutions is fixing the tendon to the perianal skin with a nonabsorbable suture for approximately 4 weeks, which is technically easy and allows for more flexibility for muscle fixation [5,6]. Once the suture and the overlying part of the tendon are removed, the muscle is usually firmly anchored, and after a few weeks, a tiny scar in the skin shows the spot were the tendon can be found if revision becomes necessary in the future.

To achieve an almost guaranteed 360° muscle coverage, we introduced a modification of the muscle wrap by bringing the tendon through the muscle belly itself-the so-called split-sling technique-which is helpful in shortening the way around the anal canal [6].

Following animal and clinical studies and based on the primary original physiological publications, we were able to reduce the muscle fiber conversion period to 4 weeks. During this time, the muscle is stimulated with a frequency of 5 Hz in a continuous mode. After 4 weeks, the frequency is raised either to 16 or 21 Hz, and tetanic contraction can be achieved in almost all patients [7]. Only in those in whom intermittent muscle relaxation despite continuous stimulation is observed (due to a probably insufficient fiber conversion) must the "training period" be prolonged.

Constipation Prescription

Constipation Prescription

Did you ever think feeling angry and irritable could be a symptom of constipation? A horrible fullness and pressing sharp pains against the bladders can’t help but affect your mood. Sometimes you just want everyone to leave you alone and sleep to escape the pain. It is virtually impossible to be constipated and keep a sunny disposition. Follow the steps in this guide to alleviate constipation and lead a happier healthy life.

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