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February 18, 1939

OPERATIVE INJURY TO THE ANAL SPHINCTER

Author Affiliations

PASADENA, CALIF.

JAMA. 1939;112(7):614-618. doi:10.1001/jama.1939.02800070030007
Abstract

Considerable confusion exists concerning the applied surgical anatomy of the sphincter mechanism of the anus as concerned with operative injury to it, with reference here particularly to that surgical trauma necessary to the cure of anal fistulas. What and where is it safe to cut? There are expressed such divergences of opinion and conception, so much patent misconception and so much lack of any conception as to warrant a review, together with a presentation of any additional information.

It is surprising to me how little attention has been called even to the fact of this confusion in proctologic literature, let alone to any attempts at elucidation. Probably the situation is in large measure explained by failure to recognize the full importance of the subject and its implications.

IMPORTANCE OF THE TOPIC  Cases of total postoperative incontinence are an obvious concern, and yet there is lack of appreciation of three important

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