Improved Outcomes in Colon and Rectal Surgery part 11. Written by many of the worlds leading colorectal surgeons, this evidence-based text investigates the risks and benefits of colorectal surgeries. By using clinical pathways, algorithms, and case discussions, the authors identify the best practices for patient safety and positive outcomes to ensure that physicians correctly recognize potential problems and carefully manage complications | IMPROVED OUTCOMES IN COLON AND RECTAL SURGERY Figure Typical Anorectal Physiology Lab with Manometry Transanal ultrasound Pudendal Nerve Terminal Motor Latency testing Biofeedback storage and equipment for sterilization. to more reliable and reproducible data these catheters are more easily and reliably cleaned from patient to patient. Pressure data is recorded continuously to computer based software that assists in creating the interpretation and the report. One critical observation of the water perfused systems is that the patient may react to the sensation of water dripping from the anus with increased tone. Scrupulous technique may avoid this. Because various technologies and methods exist for measuring anal canal pressures no universally accepted set of normal values exist. Simpson et al. addressed this issue in a study comparing five different catheters and techniques of manometry in both normal and incontinent patients. 6 Although their sample size was small 10 normal and 11 patients with incontinence the authors found no significant difference between five commonly employed devices. They were a water perfused end-hole catheter a catheter water perfused with four radially arranged side holes water filled microballoon microtransducer and an air-filled portable microprocessor controlled device. SPHINCTER PRESSURE MEASUREMENT Although written consent is not required as the patient is fully awake at our institution we obtain full informed consent and confirmation of patient identity condition being evaluated and their understanding of the tests they are about to undergo. The patients take one or two small volume cleansing enemas at home before the exam. Anal canal pressures are measured with the patient lying comfortably in the left lateral decubitus position with knees as hips flexed 90 . Some emphasis is placed on comfort and relaxation as anxiety talking and anything that increases the intraabdominal pressure may affect the results. We employ a .
