title: Anal encirclement with sphincter repair (AESR procedure) using a biological graft for anal sphincter damage involving the entire circumference.
abstract: OBJECTIVE
  The effect of a biological material to support an overlapping sphincter repair was investigated in patients with damage to the entire circumference of the external sphincter due to radiation or trauma.
  
  
  METHODS
  A tunnel is created under the damaged external anal sphincter muscle to encircle the anal canal. A biological graft (Surgisis™; 6 ply, 2×20 cm) is then inserted through the tunnel and sutured to the muscle after being pulled firmly to close the patulous anus. An overlapping repair is then carried out. Between January 2009 and June 2010, 13 patients underwent this procedure.
  
  
  RESULTS
  The average age at surgery was 68.6 years. The mean follow up was 16.3 (range 6-24) months. The average length of stay was 1 day. No complications were reported. Postoperatively, incontinence severity scores and quality of life scales [39.22 (±16.1) to 9.66 (±11.9)] showed improvement. Incontinence episodes were markedly decreased to one per week.
  
  
  CONCLUSIONS
  Anal encirclement using a biological graft with sphincter augmentation may achieve continence in patients with circumferential anal sphincter damage.
authors.affiliation: Department of Colorectal Surgery, Cleveland Clinic Foundation, Cleveland, OH 44195, USA. zutshim@ccf.org
authors.forename: M
authors.initials: M
authors.lastname: Zutshi
authors.forename: T
authors.initials: T
authors.lastname: Hull
authors.forename: B
authors.initials: B
authors.lastname: Gurland
mesh_terms: D000368:Aged; D001003:Anal Canal / Q000293:injuries / Q000528:radiation effects / Q000601:surgery*; D001672:Biocompatible Materials / Q000627:therapeutic use*; D005242:Fecal Incontinence / Q000209:etiology*; D005260:Female; D006801:Humans; D007902:Length of Stay; D008365:Manometry; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology*; D019736:Prostheses and Implants; D011788:Quality of Life; D011832:Radiation Injuries / Q000209:etiology; D011878:Radiotherapy / Q000009:adverse effects; D012720:Severity of Illness Index; D013526:Surgical Mesh
chemical_list: D001672:Biocompatible Materials