Posterior Perineal Techniques

  • Charles V. Mann
  • Richard E. Glass


Although the anterior rectal wall, rectovaginal septum and perineal body are prime areas of local weakness of the ano-rectal organ associated with incontinence and prolapse, posterior perineal procedures have always been popular when surgical correction has been attempted. From the earliest descriptions of Lange (1887) [8], Tuttle (1903) [13] and Lockhart-Mummery (1910) [9] up to the present day, many surgeons have employed the posterior approach as the method of choice for a perineal fixation of the rectum. One such repair [the post-anal (Parks) operation] [10] demands a high level of familiarity with the sphincteric anatomy. However, most surgeons are familiar with the dissection via the perineum of the tissues in the plane between the lower rectum and the front of the coccyx and sacrum as a part of their training for the abdomino-perineal (Miles) operation for cancers of the lower third of the rectum; this route can also be adapted for fixation of rectal prolapse and repair of the external anal sphincter as in the Wyatt technique (pp. 62–68).


Pelvic Floor Anal Canal Rectal Prolapse External Anal Sphincter Anal Incontinence 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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References and Further Reading

  1. 1.
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    Browning GGP, Rutter KRP, Motson RW, Neill ME (1984) Post-anal repair for idiopathic faecal incontinence. Ann R Coll Surg Engl Supplement, pp 30–33Google Scholar
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    Espiner HJ (1981) A new operation for repair of complete rectal prolapse in the elderly. Soc Med, Communication to Section of Proctology, Jan 28thGoogle Scholar
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    Hardcastle JD, Parks AG (1970) A study of anal incontinence and some principles of surgical treatment. Proc R Soc Med 63: 116PubMedPubMedCentralGoogle Scholar
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    Keighley MRB (1981) Anal function. In: Jewell D, Lee E (eds) Topics in gastroenterology. Blackwell, Oxford, pp 305–323Google Scholar
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    Keighley MRB, Fielding JWL (1983) Management of faecal incontinence and results of surgical treatment. Br J Surg 70:463PubMedCrossRefGoogle Scholar
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    Lange (1887) quoted by Carrasco AB (1934) Contribution à l’étude du prolapsus du rectum. Masson, ParisGoogle Scholar
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    Lockhart-Mummery JP (1910) A new operation for prolapse of the rectum. Lancet i: 641CrossRefGoogle Scholar
  10. 10.
    Parks AG (1975) Ano-rectal incontinence. Proc R Soc Med 68: 681PubMedPubMedCentralGoogle Scholar
  11. 11.
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    Snooks SJ, Swash M, Setchell M, Henry M (1984) Injury to innervation of pelvic floor sphincter musculature in childbirth. Lancet ii: 546CrossRefGoogle Scholar
  13. 13.
    Tuttle JP (1903) A treatise on the diseases of the anus, rectum and pelvic colon. Appleton, New York and LondonGoogle Scholar
  14. 14.
    Wyatt AP (1981) Perineal rectopexy for rectal prolapse. Br J Surg 68:717PubMedCrossRefGoogle Scholar
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    Yoshioka K, Keighley MRB (1989) Critical assessment of the quality of continence after post-anal repair for faecal incontinence. Br J Surg 76: 1054PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag London Limited 1991

Authors and Affiliations

  • Charles V. Mann
    • 1
    • 2
  • Richard E. Glass
    • 3
  1. 1.The London HospitalWhitechapel, LondonUK
  2. 2.St. Mark’s Hospital for Diseases of the Rectum and ColonLondonUK
  3. 3.Princess Margaret HospitalSwindonUK

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