By Laurence R. Sands, Dana R. Sands
A nice single-source reference encompassing all features of colorectal surgical procedure, Ambulatory Colorectal Surgery covers topics:
- patient evaluation
- anorectal anatomy
- anorectal ultrasound
- biofeedback techniques
- fecal incontinence assessment and management
- wound management
- stoma management
- pain management
- anal fissure
- anorectal abscess
- proctalgia fugax
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Additional resources for Ambulatory Colorectal Surgery
13) (29,80). 8 cm below the pubococcygeal line at rest and does not exceed 3 cm during maximal push (82,88,94). Increased PD is considered dynamic when the difference between descent during maximum evacuation and at rest is more than 3 cm. Increased PD is defined as fixed when perineal descent is more than 4 cm at rest (80,94). Puborectalis Length Puborectalis length (PRL) is measured as the distance between the pubic symphysis and the anorectal junction (80). The normal resting PRL ranges from 14 to 16 cm, while during squeeze it ranges from 12 to 15 cm, and on maximum push, ranges from 15 to 18 cm (Fig.
Investigations of the muscular architecture of the rectosigmoid junction in humans. Dis Colon Rectum 1990; 33:378–383. 5. Levi AC, Borghi F, Garavoglia M. Development of the anal canal muscles. Dis Colon Rectum 1991; 34:262–266. 6. Lunniss PJ, Phillips RKS. Anatomy and function of the anal longitudinal muscle. Br J Surg 1992; 79:882–884. 7. Tjandra JJ, Milsom Jw, Stolfi VM, et al. Endoluminal ultrasound defines anatomy of the anal canal and pelvic floor. Dis Colon Rectum 1992; 35:465–470. 8. Garavoglia M, Borghi F, Levi AC.
12 and 13) (80,82,87,88). Others draw the rectal axis through the middle of the rectal ampulla (81,89,90). The normal range of the resting ARA is between 70 and 140 degrees (82,91,92). However, during evacuation it becomes more obtuse, ranging from 110 to 180 degrees. The ARA becomes more acute during squeeze and ranges from 75 to 90 degrees (81,93,94). It is believed that the Figure 12 Landmarks used in obtaining measurements from static pictures taken during defecography. 1. Pubococcygeal line 2.