Anal and Rectal

Question 1

What is the Karydakis procedure (pilonidal cyst)?

Answer 1

Excising the entire affected area through off-midline incision, flattening the gluteal cleft

Question 2

What is the Cleft lift procedure (pilonidal cyst)?

Answer 2

Excising the entire affected area through a midline incision, creating a subctuaneous tissue flap on one side of the incision that is then mobilized and pulled over to the other side, creating an off-midline closure and flattening the gluteal cleft

Question 3

What is Goodsall’s rule? When is there an exception?

Answer 3

Describes path of anal fistula.

• Anterior fistulae track directly INTO the anal canal
• Posterior fistulae tend to take a more circuitous route to the POSTERIOR MIDLINE

Exception to this rule is fistulae that are more than 3cm away tend to go POSTERIOR no matter their skin opening

Question 4

What is the innervation of the external anal sphincter? Voluntary or involuntary control?

Answer 4

1) inferior rectal branch of the internal pudendal nerve

2) perineal branch of the fourth sacral nerve

Question 5

What muscle is the external anal sphincter continuous with?

Answer 5

puboretalis and levator ani muscles

Question 6

What is a sacral ratio, what is it used for, and what’s a good #?

Answer 6

SR = (distance from SI joint to tip of coccyx)/ distance from top of iliac crest to SI joint)

• used to evaluate sacral development in patients with anorectal malformation

ratio > 0.7 = good prognosis for fecal continence.