Digestive Disorders / Gastroenterology Expert Forum
Success of Anal Reconstruction Surgery
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Success of Anal Reconstruction Surgery


  I was diagnosed with Crohn's in Feb. 1993.  In Oct. 1992, I had surgery for a perirectal abcess (abscess), thought to be caused by a suture from an episiotomy in Dec. 1991.  Needless to say, it was caused by the then undiagnosed Crohn's Disease.  Following the surgery, I now have NO bowel control.  This makes for very, very low quality of life.  I wear pads all the time, in case of an accident, don't eat away from home & am so tired of accidents, at home & away, that I could scream.  I discussed ostomy surgery with my GI just to get rid of this problem.  I know the Crohn's will never go away & the surgery wouldn't stop the frequent BM's, but it would at least let me leave the house without worrying!  He suggested I consider anal reconstructive surgery first. He said there are only a handfull of MD's that do this type of surgery & that with the surgery & "exercises" I might regain some bowel control.  My main concern is that I would go thru the pain of surgery & still not regain control.  My questions are:  what is the success rate with this type surgery, are there any qualified surgeons in Houston, TX?  
_________
Dear Jackie,
I empathize with your story and appreciate the problems that you have with incontinence.  The problem with the sphincter mechanism should be defined before you consider your therapeutic options.  The tests to describe sphincter function and anatomy are an analrectal motility study (measures the pressures in the internal and external sphincters) and a rectal ultrasound that assesses the anatomy.  This information is necessary before your options are described.
You are correct that patients with your type of incontinence and Crohn's disease often end up having multiple procedures.  Although your physicians will examine the rectal mucosa to determine if you have active Crohn's disease, the absence of active inflammation does not mean that you will have an uneventful postoperative course.  You may still have breakdown of any surgical anastomosis.  
In general, surgeons will try to perform the simplest operation necessary to fix the problem. If a correctible sphincter defect is identifed, the surgeons may try to repair it, sometimes adding a diverting ileostomy to allow time for healing.  Unfortunately, the surgical repair may still breakdown leading to infection and the need for further operations.
Complete cure would come if you had a proctocolectomy and permanent ileostomy i.e. your entire colon and rectum are removed and an ileostomy is done.  This is very dramatic surgery and you should only consider such an option if you "scream all the time" and want to regain control of your life.  
If you want to visit Detroit, Dr Wu of our department of Colorectal Surgery would be happy to lead your evaluation and explain your options.  You can arrange an appoinment by calling (313)876-2497.  Dr Wu recommends Dr, Randolph Bailey as a colorectal surgeon in Houston.
This information is presented for educational purposes only.  Always consult your personal physician for specific medical questions.
HFHSM.D.-rf
*keywords: Crohn's Disease, incontinence. surgery
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