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Chrusciel J, Ndoye R, Ndiongue BM, Fournier MA, Kabirian F, Pondjikli M, Dutheillet-de-Lamothe V, Berrut G, Rolland Y, Sanchez S. Predictive value of a self-administered frailty screening questionnaire for the effectiveness of functional rehabilitation evaluated with the locomotor functional independence measure in a geriatric rehabilitation unit: a multicentre cohort study. BMC Geriatr 2024; 24:1013. [PMID: 39702184 DOI: 10.1186/s12877-024-05605-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 12/03/2024] [Indexed: 12/21/2024] Open
Abstract
BACKGROUND Patient Reported Outcome Measures (PROMs) are questionnaires that collect health data directly from the patient, without any intervention from a third party. The aim of rehabilitation units is to restore function. Functional gain can be evaluated with classic scales, such as the locomotor subscale of the Functional Independence Measure. This study aimed to assess the accuracy of a new self-assessment questionnaire pertaining to physical, sensory and cognitive ability (abbreviated SEPCO) for the prediction of functional prognosis in older patients admitted to a rehabilitation unit. METHODS In this multicentre observational study including patients admitted to 12 rehabilitation centres in France, all included patients completed the SEPCO on admission. Poor response to rehabilitation was defined as relative effectiveness < 40% on the evolution of the locomotor FIM subscale. Components of the questionnaire potentially associated with the outcome of rehabilitation were confirmed for inclusion upon expert review and summed to form an overall score. The final score had five components: the depression score of the HADS, the SOFRESC vision score, the SOFRESC balance score, the stress urinary incontinence subscale of the USP, and the EPICES socio-economic deprivation score. A logistic regression model adjusted for baseline characteristics assessed the performance of the SEPCO score to predict change in functional status, defined by the relative functional gain for the locomotion subscale of the Functional Independence Measure (FIM). RESULTS A total of 153 patients (mean age 79.2 ± 8.1 years, 72.5% women) were included. By multivariate analysis, a 5-scale SEPCO score ≥ 1.1 predicted worse functional improvement with an odds ratio (OR) of 2.575, 95% Confidence Interval (CI) 1.081 to 6.133, p = 0.03. Sensitivity for this threshold was 67.4% (95% CI 52.0-80.5%), with a specificity of 58.8% (95% CI 46.2-70.6%). Having a SEPCO ≥ 1.1 almost doubled the probability of poor response to rehabilitation (from 27.3 to 52.5%). CONCLUSION The SEPCO score can predict poor functional gain from rehabilitation. Future studies should validate this score on an external cohort. The SEPCO could serve as a complement to the initial clinical evaluation performed by physicians, and assist physicians in setting each patient's rehabilitation goals.
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Affiliation(s)
- Jan Chrusciel
- Department of Public Health, Hôpitaux Champagne Sud, Troyes, France.
| | - Ramatoulaye Ndoye
- Research Department, Gérontopôle des Pays de la Loire, Nantes, France
| | - Biné-Mariam Ndiongue
- Department of Research and Innovation, Fondation Korian pour le Bien Vieillir, Paris, France
| | - Marie-Anne Fournier
- Department of Research and Innovation, Fondation Korian pour le Bien Vieillir, Paris, France
| | - Fariba Kabirian
- Department of Research and Innovation, Fondation Korian pour le Bien Vieillir, Paris, France
| | - Manon Pondjikli
- Research Department, Gérontopôle des Pays de la Loire, Nantes, France
| | | | - Gilles Berrut
- Research Department, Gérontopôle des Pays de la Loire, Nantes, France
- Department of Research and Innovation, Fondation Korian pour le Bien Vieillir, Paris, France
| | - Yves Rolland
- Gérontopôle de Toulouse, CHU de Toulouse, Toulouse, France
| | - Stéphane Sanchez
- Department of Public Health, Hôpitaux Champagne Sud, Troyes, France
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Milito P, Piozzi GN, Hussain MI, Dragani TA, Sorrentino L, Cosimelli M, Guaglio M, Battaglia L. Effect of neoadjuvant chemoradiation on anorectal function assessed with anorectal manometry: A systematic review and meta-analysis. TUMORI JOURNAL 2024; 110:284-294. [PMID: 38819198 PMCID: PMC11295399 DOI: 10.1177/03008916241256544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 04/19/2024] [Accepted: 05/06/2024] [Indexed: 06/01/2024]
Abstract
AIM Improvement in oncological survival for rectal cancer increases attention to anorectal dysfunction. Diagnostic questionnaires can evaluate quality of life but are subjective and dependent on patients' compliance. Anorectal manometry can objectively assess the continence mechanism and identify functional sphincter weakness and rectal compliance. Neoadjuvant chemoradiotherapy is presumed to affect anorectal function. We aim to assess anorectal function in rectal cancer patients who undergo total mesorectal excision, with or without neoadjuvant chemoradiation, using anorectal manometry measurements. METHOD MEDLINE, Embase, and Cochrane databases were searched for studies comparing perioperative anorectal manometry between neoadjuvant chemoradiation and upfront surgery for rectal cancers. Primary outcomes were resting pressure, squeeze pressure, sensory threshold volume and maximal tolerable volume. RESULTS Eight studies were included in the systematic review, of which seven were included for metanalysis. 155 patients (45.3%) had neoadjuvant chemoradiation before definitive surgery, and 187 (54.6%) underwent upfront surgery. Most patients were male (238 vs. 118). The standardized mean difference of mean resting pressure, mean and maximum squeeze pressure, maximum resting pressure, sensory threshold volume, and maximal tolerable volume favored the upfront surgery group but without statistical significance. CONCLUSION Currently available evidence on anorectal manometry protocols failed to show any statistically significant differences in functional outcomes between neoadjuvant chemoradiation and upfront surgery. Further large-scale prospective studies with standardized neoadjuvant chemoradiation and anorectal manometry protocols are needed to validate these findings.
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Affiliation(s)
- Pamela Milito
- Department of Emergency and General Surgery, IRCCS Policlinico San Donato, Milan, Italy
- Colorectal Surgery Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Guglielmo Niccolò Piozzi
- Colorectal Surgery Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
- Department of Colorectal Surgery, Portsmouth Hospitals University NHS Trust, Portsmouth, UK
| | | | - Tommaso A. Dragani
- Department of Research, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Luca Sorrentino
- Colorectal Surgery Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Maurizio Cosimelli
- Colorectal Surgery Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Marcello Guaglio
- Colorectal Surgery Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Luigi Battaglia
- Colorectal Surgery Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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Liptak P, Duricek M, Banovcin P. Diagnostic tools for fecal incontinence: Scoring systems are the crucial first step. World J Gastroenterol 2024; 30:516-522. [PMID: 38463021 PMCID: PMC10921147 DOI: 10.3748/wjg.v30.i6.516] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 12/15/2023] [Accepted: 01/15/2024] [Indexed: 02/05/2024] Open
Abstract
The main aim of this editorial is to comment on the recent article published by Garg et al in the World Journal of Gastroenterology 2023; 29: 4593-4603. This original research presents a new scoring system for fecal incontinence. Fecal incontinence is a chronic disease with a severe impact on the quality of life of the patients. Substantial social stigmatization often leads to significant underreporting of the condition even during visits to a specialist and could lead to further mismanagement or non-existent management of the disease. An important fact is that patients are often unable to describe their condition when not asked precisely defined questions. This problem is partially resolved by scoring questionnaires. Several scoring systems are commonly used; however, each of them has their shortcomings. For example, the absence of different kinds of leakage besides flatus and stool could further lead to underscoring the incontinence severity. Therefore, there has long been a call for a more precise scoring system. The correct identification of the presence and severity of fecal incontinence is paramount for further diagnostic approach and for choosing the appropriate therapy option. This editorial describes fecal incontinence, its effect on quality of life in general and further evaluates the diagnostic approach with a particular focus on symptom scoring systems and their implications for clinical practice.
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Affiliation(s)
- Peter Liptak
- Clinic of Internal Medicine- Gastroenterology, University Hospital in Martin, Jessenius Faculty of Medicine in Martin, Comenius University, Martin 03601, Slovakia
| | - Martin Duricek
- Clinic of Internal Medicine- Gastroenterology, University Hospital in Martin, Jessenius Faculty of Medicine in Martin, Comenius University, Martin 03601, Slovakia
| | - Peter Banovcin
- Clinic of Internal Medicine- Gastroenterology, University Hospital in Martin, Jessenius Faculty of Medicine in Martin, Comenius University, Martin 03601, Slovakia
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Julienne A, Gourcerol G, Amarenco G, Turmel N, Leroi AM, Desprez C. Fecal Incontinence Subtype Assessment (FI-SA): Validation of a new tool to distinguish among subtypes of fecal incontinence. Clin Res Hepatol Gastroenterol 2024; 48:102275. [PMID: 38158155 DOI: 10.1016/j.clinre.2023.102275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 12/13/2023] [Accepted: 12/27/2023] [Indexed: 01/03/2024]
Abstract
PURPOSE Three subtypes of fecal incontinence (FI) are described in the literature: urge, mixed and passive FI, but the relevance of this classification remains unknown. To our knowledge, no questionnaire has been validated in a general population of patients with FI to classify patients between the different subtypes of FI. The aim of the present study was to validate the Fecal Incontinence Subtype Assessment (FI-SA) questionnaire in a general population of patients with FI. METHODS All consecutive patients referred to our unit for physiological investigations of anorectal function in case of FI were included. A feasibility study was done to assess the acceptability, understanding, and the reproducibility of the FI-SA questionnaire. Its performance to correctly classify patients between subtypes of FI was evaluated in both a feasibility study and in a validation study, using clinical interview as gold standard. RESULTS The FI-SA questionnaire was found to be well accepted and easily understood by patients. Moreover, it was filled rapidly by patients, with a good reproducibility with an intra-class correlation coefficient of 0.97 and 0.87 for questions 1 and 2. Lastly, the accuracy of the FI-SA questionnaire to predict subtypes of FI was 93.3 % in the feasibility study (n = 30) and 81.1 % in the validation study (n = 100), in comparison with clinical interview as gold standard. CONCLUSION The FI-SA questionnaire could be used in the future to help standardize the methodology used among studies to evaluate the classification of patients in different subtypes of FI and ultimately to guide therapeutics.
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Affiliation(s)
- Audrey Julienne
- CHU Rouen, Department of Digestive Physiology, F-76000 Rouen, France
| | - Guillaume Gourcerol
- CHU Rouen, Department of Digestive Physiology, F-76000 Rouen, France; Normandie Univ, UNIROUEN, Nutrition, Brain and Gut Laboratory, INSERM 1073, F-76000 Rouen, France
| | - Gérard Amarenco
- Sorbonne Université, GRC 001, GREEN Groupe de Recherche Clinique en Neuro-Urologie, AP-HP, Hôpital Tenon, 75020 Paris, France
| | | | - Anne-Marie Leroi
- CHU Rouen, Department of Digestive Physiology, F-76000 Rouen, France; Normandie Univ, UNIROUEN, Nutrition, Brain and Gut Laboratory, INSERM 1073, F-76000 Rouen, France; CHU Rouen, INSERM CIC-CRB 1404, F-76000 Rouen, France
| | - Charlotte Desprez
- CHU Rouen, Department of Digestive Physiology, F-76000 Rouen, France; Normandie Univ, UNIROUEN, Nutrition, Brain and Gut Laboratory, INSERM 1073, F-76000 Rouen, France.
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Desprez C, Turmel N, Chesnel C, Sheikh Ismael S, Tamiatto M, Tan E, Haddad R, Le Breton F, Leroi AM, Hentzen C, Amarenco G. Fecal incontinence subtype assessment (FI-SA): A new tool to distinguish among subtypes of fecal incontinence in a neurogenic population. Clin Res Hepatol Gastroenterol 2022; 46:101900. [PMID: 35259498 DOI: 10.1016/j.clinre.2022.101900] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 02/15/2022] [Accepted: 02/18/2022] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Two subtypes of fecal incontinence (FI) are defined in the literature (urge and passive FI). The pertinence of this classification is unknown due to conflicting findings and heterogeneity of definitions. However, no questionnaire is available to clearly classify patients among subtypes. The objective of the present study was to develop and validate a new tool (Fecal incontinence subtype assessment, FI-SA) in order to better classify patients among the different subtypes of FI. METHODS A prospective monocentric study was conducted in consecutive patients with FI according to Rome IV criteria. To validate psychometric properties of the FI-SA questionnaire, a literature review and qualitative interviews were performed and discussed with an expert panel. A feasibility study was realized to assess acceptability and comprehension of items. The reproducibility was investigated in a validation study. RESULTS Comprehension and acceptability were excellent in 90% of patients in the feasibility study (n = 30). Validation study (n = 100) showed a good reproducibility with an intra-class correlation coefficient of 0.91 and 0.89 for questions 1 and 2. Time to fill the questionnaire was 40.0 s. 98.0% patients were classified among subtypes of FI: 34.0% passive FI, 32.0% urge FI and 32.0% mixed FI. CONCLUSION FI-SA is the first questionnaire to classify patients among subtypes of FI with good psychometric characteristics and the first questionnaire introducing the concept of mixed FI. FI-SA could help to determine the pertinence of this classification of FI in the management of these patients.
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Affiliation(s)
- C Desprez
- Sorbonne Université, GRC 001, GREEN Groupe de Recherche Clinique en Neuro-Urologie, AP-HP, Hôpital Tenon, 75020 Paris, France; Rouen University Hospital, Digestive physiology Department, 76000 Rouen, France.
| | - N Turmel
- Sorbonne Université, GRC 001, GREEN Groupe de Recherche Clinique en Neuro-Urologie, AP-HP, Hôpital Tenon, 75020 Paris, France; Casanova Hospital, 93200 Saint-Denis, France
| | - C Chesnel
- Sorbonne Université, GRC 001, GREEN Groupe de Recherche Clinique en Neuro-Urologie, AP-HP, Hôpital Tenon, 75020 Paris, France
| | - S Sheikh Ismael
- Sorbonne Université, GRC 001, GREEN Groupe de Recherche Clinique en Neuro-Urologie, AP-HP, Hôpital Tenon, 75020 Paris, France; ELSAN, Clinique Le Floride, 66420 Le Barcarès, France
| | - M Tamiatto
- Sorbonne Université, GRC 001, GREEN Groupe de Recherche Clinique en Neuro-Urologie, AP-HP, Hôpital Tenon, 75020 Paris, France
| | - E Tan
- Sorbonne Université, GRC 001, GREEN Groupe de Recherche Clinique en Neuro-Urologie, AP-HP, Hôpital Tenon, 75020 Paris, France
| | - R Haddad
- Sorbonne Université, GRC 001, GREEN Groupe de Recherche Clinique en Neuro-Urologie, AP-HP, Hôpital Tenon, 75020 Paris, France
| | - F Le Breton
- Sorbonne Université, GRC 001, GREEN Groupe de Recherche Clinique en Neuro-Urologie, AP-HP, Hôpital Tenon, 75020 Paris, France
| | - A-M Leroi
- Rouen University Hospital, Digestive physiology Department, 76000 Rouen, France
| | - C Hentzen
- Sorbonne Université, GRC 001, GREEN Groupe de Recherche Clinique en Neuro-Urologie, AP-HP, Hôpital Tenon, 75020 Paris, France
| | - G Amarenco
- Sorbonne Université, GRC 001, GREEN Groupe de Recherche Clinique en Neuro-Urologie, AP-HP, Hôpital Tenon, 75020 Paris, France
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D'Orazio B, Geraci G, Famà F, Terranova G, Di Vita G. Botulinum toxin associated with fissurectomy and anoplasty for hypertonic chronic anal fissure: A case-control study. World J Clin Cases 2021; 9:9722-9730. [PMID: 34877311 PMCID: PMC8610929 DOI: 10.12998/wjcc.v9.i32.9722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 05/07/2021] [Accepted: 08/25/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Lateral internal sphincterotomy is still the approach of choice for the treatment of chronic anal fissure (CAF) with internal anal sphincter (IAS) hypertonia, but it is burdened by high-risk postoperative faecal incontinence (FI). Sphincter saving procedures have recently been reconsidered as treatments to overcome this risk. The most employed procedure is fissurectomy with anoplasty, eventually associated with pharmacological sphincterotomy.
AIM To evaluate whether fissurectomy and anoplasty with botulinum toxin injection improves the results of fissurectomy and anoplasty alone.
METHODS We conducted a case-control study involving 30 male patients affected by CAF with hypertonic IAS who underwent fissurectomy and anoplasty with V-Y cutaneous flap advancement. The patients were divided into two groups: Those in group I underwent surgery alone, and those in group II underwent surgery and a botulinum toxin injection directly into the IAS. They were followed up for at least 2 years. The goals were to achieve complete healing of the patient and to assess the FI and recurrence rate along with manometry parameters.
RESULTS The intensity and duration of post-defecatory pain decreased significantly in both groups of patients starting with the first defecation, and this reduction was higher in group II. Forty days after surgery, we achieved complete wound healing in all the patients in group II but only in 80% of the patients in group I (P < 0.032). We recorded 2 cases of recurrence, one in each group, and both healed with conservative therapy. We recorded one temporary and low-grade postoperative case of “de novo” FI. Manometry parameters reverted to the normal range earlier for group II patients.
CONCLUSION The injection of botulinum toxin A in association with fissurectomy and anoplasty with a V-Y advancement flap improves the results of surgery alone in patients affected by CAF with IAS hypertonia.
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Affiliation(s)
- Beatrice D'Orazio
- Department of Surgical, Oncological and Stomatological Sciences, University of Palermo, Palermo 90100, Sicily, Italy
| | - Girolamo Geraci
- Department of Surgical, Oncological and Stomatological Sciences, University of Palermo, Palermo 90100, Sicily, Italy
| | - Fausto Famà
- Department of Human Pathology in Adulthood and Childhood "G. Barresi", University Hospital of Messina, Messina 98121, Sicily, Italy
| | - Gloria Terranova
- Department of Surgical, Oncological and Stomatological Sciences, Postgraduate Medical School in General Surgery, University of Palermo, Palermo 90100, Sicily, Italy
| | - Gaetano Di Vita
- Department of Surgical, Oncological and Stomatological Sciences, University of Palermo, Palermo 90100, Sicily, Italy
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D'Orazio B, Geraci G, Bonventre S, Calì D, Di Vita G. Safety and effectiveness of saving sphincter procedure in the treatment of chronic anal fissure in female patients. BMC Surg 2021; 21:350. [PMID: 34560857 PMCID: PMC8461903 DOI: 10.1186/s12893-021-01346-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 09/13/2021] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Lateral internal sphincterotomy (LIS) is still the approach of choice for the treatment of chronic anal fissure (CAF) regardless to the internal anal sphincter tone but it is burdened by high risk post-operative faecal incontinence (FI). In female patient there are some anatomical and functional differences of the sphinteric system which make them more at risk of FI and vaginal birth could cause sphinteric lesions affecting the anal continence function. The aim of our study is to evaluate the results of saving sphincter procedure as treatment for female patients affected by CAF. METHODS We studied 110 female patients affected by CAF undergone fissurectomy and anoplasty with V-Y cutaneous flap advancement associating pharmacological sphincterotomy in patients with hypertonic IAS. The follow up was at least for 2 years. The goals were patient's complete healing, the evaluation of FI, recurrence rate and manometry parameters. RESULTS All wounds healed within 40 days after surgery. We recorded 8 cases of recurrences 6 healed with medical therapy and 2 with dilatation. We recorded 2 "de novo" temporary and low grade post-operative cases of FI. Post-operative value of MRP were unmodified in patient with normotonic IAS but significantly lower at 12 months follow up as compared with the pre-operative ones in patients with hypertonic IAS; after 24 months from surgery MRP values were within the normal range. CONCLUSION The fissurectomy and anoplasty with V-Y cutaneous flap alone or in association with a pharmacological sphincterotomy in patients with hypertonic IAS may represent an effective approach for the treatment of CAF in female patients.
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Affiliation(s)
- Beatrice D'Orazio
- General Surgery Unit, Department of Surgical, Oncological and Stomatological Sciences, University of Palermo, Via Liborio Giuffrè, 5, 90127, Palermo, Italy
| | - Girolamo Geraci
- General Surgery Unit, Department of Surgical, Oncological and Stomatological Sciences, University of Palermo, Via Liborio Giuffrè, 5, 90127, Palermo, Italy
| | - Sebastiano Bonventre
- General Surgery Unit, Department of Surgical, Oncological and Stomatological Sciences, University of Palermo, Via Liborio Giuffrè, 5, 90127, Palermo, Italy
| | - Dario Calì
- General Surgery Unit, Department of Surgical, Oncological and Stomatological Sciences, University of Palermo, Via Liborio Giuffrè, 5, 90127, Palermo, Italy
- Postgraduate Medical School in General Surgery, University of Palermo, Palermo, Italy
| | - Gaetano Di Vita
- General Surgery Unit, Department of Surgical, Oncological and Stomatological Sciences, University of Palermo, Via Liborio Giuffrè, 5, 90127, Palermo, Italy.
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Spinelli A, Laurenti V, Carrano FM, Gonzalez-Díaz E, Borycka-Kiciak K. Diagnosis and Treatment of Obstetric Anal Sphincter Injuries: New Evidence and Perspectives. J Clin Med 2021; 10:3261. [PMID: 34362045 PMCID: PMC8347477 DOI: 10.3390/jcm10153261] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 07/18/2021] [Accepted: 07/19/2021] [Indexed: 12/15/2022] Open
Abstract
Perineal injury during childbirth is a common event with important morbidity associated in particular with third-and-fourth degree perineal tears (also referred to as obstetric anal sphincter injuries-OASIS). Early diagnosis of these damages is mandatory to define a prompt therapeutic strategy and thus avoid the development of late-onset consequences, such as faecal incontinence. For this purpose, various diagnostic exams can be performed after a thorough clinical examination. The management of OASIS includes several measures and should be individualized according to the timing and features of the clinical presentation.
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Affiliation(s)
- Antonino Spinelli
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090 Milan, Italy; (V.L.); (F.M.C.)
- IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Milan, Italy
| | - Virginia Laurenti
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090 Milan, Italy; (V.L.); (F.M.C.)
- IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Milan, Italy
| | - Francesco Maria Carrano
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090 Milan, Italy; (V.L.); (F.M.C.)
- IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Milan, Italy
| | - Enrique Gonzalez-Díaz
- Pelvic Floor Unit, Department of Obstetrics and Gynaecology, Complejo Asistencial Universitario de León (CAULE), C/Altos de Nava S/N, 24080 León, Spain;
- Department of Obstetrics and Gynaecology, Complejo Asistencial Universitario de León (CAULE), C/Altos de Nava S/N, 24080 León, Spain
| | - Katarzyna Borycka-Kiciak
- Department of Colorectal, General and Oncological Surgery, Centre of Postgraduate Medical Education, 80, Ceglowska Street, 01810 Warsaw, Poland;
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Tucker J, Steen M, Briley A. Enhancing the identification of anal incontinence in women of reproductive age. Nurs Stand 2021; 36:71-76. [PMID: 33870661 DOI: 10.7748/ns.2021.e11735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/24/2021] [Indexed: 11/09/2022]
Abstract
Anal incontinence is an unpredictable and debilitating condition that can significantly reduce quality of life. Symptoms include the involuntary loss of solid and/or liquid stool, flatus incontinence and rectal urgency. Pregnancy and childbirth are two major factors that increase the risk of anal incontinence in women of reproductive age. Women at high risk of anal incontinence include those with a known history of the condition and those who have experienced severe perineal trauma, particularly after injury to the anal sphincters (third-degree and fourth-degree tears). Routine screening for anal incontinence of women in high-risk groups during pregnancy and after childbirth appears to be limited in clinical practice. This article discusses the potential benefits of screening for anal incontinence, outlines the factors that inhibit and enable screening, describes current bowel screening tools and their limitations, and explores how the identification of anal incontinence in women of reproductive age could be improved.
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Affiliation(s)
| | - Mary Steen
- professorial lead for maternal and family health, Clinical and Health Sciences, University of South Australia, Adelaide, Australia
| | - Annette Briley
- College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
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Desprez C, Turmel N, Chesnel C, Mistry P, Tamiatto M, Haddad R, Le Breton F, Leroi AM, Hentzen C, Amarenco G. Comparison of clinical and paraclinical characteristics of patients with urge, mixed, and passive fecal incontinence: a systematic literature review. Int J Colorectal Dis 2021; 36:633-644. [PMID: 33210162 DOI: 10.1007/s00384-020-03803-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/11/2020] [Indexed: 02/04/2023]
Abstract
PURPOSE Two subgroups of fecal incontinence (FI) are described in literature and used in clinical practice. However, the pertinence of this classification of FI is still unknown as there are no clear established guidelines. To a better understanding, we performed a systematic review to characterize the different types of FI (active, passive, or mixed) on the basis of clinical presentation and complementary explorations. METHODS This systematic literature review was performed in reference to recommendations for systematic review using PRISMA guidelines without date restriction, until May 2020. This systematic review was performed without temporal limitation using MEDLINE-PubMed, Cochrane Library, and Google Scholar databases. RESULTS Six hundred nine unique citations were identified from all the databases combined. Of those, 21 studies met the inclusion criteria, with 8 retrospective observational studies and 13 prospective observational studies. There was a lack of homogeneity in definitions of passive and urge (active) FI among studies. Prevalence of passive and urge FI was respectively of 4.0-5.0 and 15.0-35.0%. Clinical characteristics, physical examination, and endoanal imaging were not evaluated in most studies. In anorectal manometry, maximal squeeze pressure was higher in passive FI subgroup in most studies and results regarding maximal resting pressure remain discordant. There seemed to be no difference regarding first sensation volume and maximal tolerable volume among subgroups. A few studies evaluated pudendal terminal nerve motor latency with no difference among subgroups. CONCLUSION There is a lack of well-conducted prospective studies comparing the different subtypes of FI with validated definitions in both clinical and paraclinical examinations.
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Affiliation(s)
- Charlotte Desprez
- GRC 001, GREEN Groupe de Recherche Clinique en Neuro-Urologie, AP-HP, Hôpital Tenon, Sorbonne Université, 75020, Paris, France. .,Digestive physiology Unit, Rouen University Hospital, 1 rue de Germont, 76031, Rouen, France.
| | - N Turmel
- GRC 001, GREEN Groupe de Recherche Clinique en Neuro-Urologie, AP-HP, Hôpital Tenon, Sorbonne Université, 75020, Paris, France
| | - C Chesnel
- GRC 001, GREEN Groupe de Recherche Clinique en Neuro-Urologie, AP-HP, Hôpital Tenon, Sorbonne Université, 75020, Paris, France
| | - P Mistry
- GRC 001, GREEN Groupe de Recherche Clinique en Neuro-Urologie, AP-HP, Hôpital Tenon, Sorbonne Université, 75020, Paris, France
| | - M Tamiatto
- GRC 001, GREEN Groupe de Recherche Clinique en Neuro-Urologie, AP-HP, Hôpital Tenon, Sorbonne Université, 75020, Paris, France
| | - R Haddad
- GRC 001, GREEN Groupe de Recherche Clinique en Neuro-Urologie, AP-HP, Hôpital Tenon, Sorbonne Université, 75020, Paris, France
| | - F Le Breton
- GRC 001, GREEN Groupe de Recherche Clinique en Neuro-Urologie, AP-HP, Hôpital Tenon, Sorbonne Université, 75020, Paris, France
| | - A-M Leroi
- Digestive physiology Unit, Rouen University Hospital, 1 rue de Germont, 76031, Rouen, France
| | - C Hentzen
- GRC 001, GREEN Groupe de Recherche Clinique en Neuro-Urologie, AP-HP, Hôpital Tenon, Sorbonne Université, 75020, Paris, France
| | - G Amarenco
- GRC 001, GREEN Groupe de Recherche Clinique en Neuro-Urologie, AP-HP, Hôpital Tenon, Sorbonne Université, 75020, Paris, France
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11
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Rodrigues BDS, Reis IGN, Coelho FMDO, Buzatti KCDLR. Fecal incontinence and quality of life assessment through questionnaires. JOURNAL OF COLOPROCTOLOGY 2021. [DOI: 10.1016/j.jcol.2017.06.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Abstract
Background: Fecal incontinence causes a big impact on patient's quality of life. Our study analyzed the main questionnaires about fecal incontinence available internationally, aiming to delineate vantages and limitations of these instruments and their application, to mention the cultural aspects involved in the process of development and validation, as well as to suggest a reflection about the complexity of this matter. Results: Four of the instruments (Pescatori score, FISI, MSKCC bowel function instrument, and LARS score) do not include quality of life, working only as diagnostic tools. Two others, ‘Jorge and Wexner Fecal Incontinence score’, and ‘St Marks’ Fecal incontinence grading system’ can diagnose and grade fecal incontinence, however they are very subtle in assessing quality of life. The ‘EORTC Colorectal Cancer-specific’, on the other hand, focuses exclusively on quality of life. Although the ‘FIQL’ questionnaire assesses quality of life related to fecal incontinence, it does not measure leakage. Lastly, the ‘RAFIS’ assesses both aspects but too superficially. Conclusion: None of the questionnaires analyzed were able to simultaneously assess both fecal incontinence and quality of life successfully. Furthermore, the concepts related to fecal incontinence have different meanings depending on the cultural and psychosocial context. These differences are even greater when individuals of developed countries like the ones where these questionnaires were developed are compared to the ones of developing countries, such as Brazil, which makes its very hard for these instruments to be used universally.
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Affiliation(s)
- Beatriz Deoti Silva Rodrigues
- Associate Professor of Surgery, School of Medicine – Department of Surgery – Universidade Federal de Minas Gerais (UFMG)
- Member of the Coloproctology Staff, Hospital das Clínicas – UFMG
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12
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Maeda K, Yamana T, Takao Y, Mimura T, Katsuno H, Seki M, Tsunoda A, Yoshioka K. Japanese Practice Guidelines for Fecal Incontinence Part 1-Definition, Epidemiology, Etiology, Pathophysiology and Causes, Risk Factors, Clinical Evaluations, and Symptomatic Scores and QoL Questionnaire for Clinical Evaluations-English Version. J Anus Rectum Colon 2021; 5:52-66. [PMID: 33537501 PMCID: PMC7843140 DOI: 10.23922/jarc.2020-057] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 10/08/2020] [Indexed: 12/12/2022] Open
Abstract
Fecal incontinence (FI) is defined as involuntary or uncontrollable loss of feces. Gas incontinence is defined as involuntary or uncontrollable loss of flatus, while anal incontinence is defined as the involuntary loss of feces or flatus. The prevalence of FI in people over 65 in Japan is 8.7% in the male population and 6.6% among females. The etiology of FI is usually not limited to one specific cause, with risk factors for FI including physiological factors, such as age and gender; comorbidities, such as diabetes and irritable bowel syndrome; and obstetric factors, such as multiple deliveries, home delivery, first vaginal delivery, and forceps delivery. In the initial clinical evaluation of FI, the factors responsible for individual symptoms are gathered from the history and examination of the anorectal region. The evaluation is the basis of all medical treatments for FI, including initial treatment, and also serves as a baseline for deciding the need for a specialized defecation function test and selecting treatment in stages. Following the general physical examination, together with history taking, inspection (including anoscope), and palpation (including digital anorectal and vaginal examination) of the anorectal area, clinicians can focus on the causes of FI. For the clinical evaluation of FI, it is useful to use Patient-Reported Outcome Measures (PROMs), such as scores and questionnaires, to evaluate the symptomatic severity of FI and its influence over quality of life (QoL).
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Affiliation(s)
- Kotaro Maeda
- International Medical Center Fujita Health University Hospital, Toyoake, Japan
| | - Tetsuo Yamana
- Department of Coloproctology, Tokyo Yamate Medical Center, Tokyo, Japan
| | - Yoshihiko Takao
- Division of Colorectal Surgery, Department of Surgery, Sanno Hospital, Tokyo, Japan
| | - Toshiki Mimura
- Department of Surgery, Jichi Medical University, Tochigi, Japan
| | - Hidetoshi Katsuno
- Department of Surgery, Fujita Health University Okazaki Medical Center, Okazaki, Japan
| | - Mihoko Seki
- Nursing Division, Tokyo Yamate Medical Center, Tokyo, Japan
| | - Akira Tsunoda
- Department of Gastroenterological Surgery, Kameda Medical Center, Kamogawa, Japan
| | - Kazuhiko Yoshioka
- Department of Surgery, Kansai Medical University Medical Center, Osaka, Japan
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13
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Fehlmann A, Reichetzer B, Ouellet S, Tremblay C, Clermont ME. Establishing a peripartum perineal trauma clinic: a narrative review. Int Urogynecol J 2021; 32:1653-1662. [PMID: 33399903 DOI: 10.1007/s00192-020-04631-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Accepted: 11/30/2020] [Indexed: 12/18/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Obstetric anal sphincter injury (OASI) is not rare, and its consequences are multiple and potentially severe, especially for young women. Some dedicated perineal clinics have been established to improve the management of OASI. Despite their obvious importance, these specific clinics are underrepresented and underdeveloped. The objectives of this review are to explore various options for developing a peripartum perineal clinic and to compare the different practices regarding the mode of delivery for subsequent pregnancies after an OASI. METHODS This narrative review covers information from patients' questionnaires specific to anal incontinence, anal physiology assessment, pelvic floor and anal sphincter imaging, and the arguments for choosing the mode of delivery after an OASI. RESULTS This review highlights the extensive range of practices regarding the delivery mode after an OASI throughout national professional organizations and experienced perineal clinics. CONCLUSION This review summarizes the different choices in developing a perineal clinic to facilitate their development in promoting health care and education specific for peripartum women concerning the perineal consequences of delivery for obstetrician-gynaecologists, family doctors, and residents.
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Affiliation(s)
- Aurore Fehlmann
- Department of Obstetrics and Gynaecology, Université de Montréal and Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Canada.
- Department of Paediatrics, Gynaecology and Obstetrics, Geneva University Hospitals and Faculty of Medecine, Geneva, Switzerland.
| | - Barbara Reichetzer
- Department of Obstetrics and Gynaecology, Université de Montréal and Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Canada
| | - Stéphane Ouellet
- Department of Obstetrics and Gynaecology, Université de Montréal and Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Canada
| | - Catherine Tremblay
- Department of Obstetrics and Gynaecology, Université de Montréal and Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Canada
| | - Marie-Eve Clermont
- Department of Obstetrics and Gynaecology, Université de Montréal and Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Canada
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14
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Hunt CW, Cavallaro PM, Bordeianou LG. Metrics Used to Quantify Fecal Incontinence and Constipation. Clin Colon Rectal Surg 2021; 34:5-14. [PMID: 33536844 PMCID: PMC7843947 DOI: 10.1055/s-0040-1714245] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
While fecal incontinence and constipation can be measured through physiological testing, the subjective experience of severity and impact on health-related quality of life lead to both being most effectively captured through patient-reported measures. Patient-reported measures of severity and impact help to determine baseline symptoms, guide clinical decision making, and compare various treatments. Here, we take pause to review the psychometric qualities that make effective instruments, and discuss some of the most commonly used instruments along with the reasons behind their use. In addition, we highlight the benefits of a standardized instrument designed to evaluate the major symptoms of patients presenting with pelvic floor disorders (including fecal incontinence and constipation). Ultimately, we aim to provide guidance in choosing appropriate instruments for clinical and research use.
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Affiliation(s)
- Cameron W. Hunt
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Paul M. Cavallaro
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Liliana G. Bordeianou
- Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
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15
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Scott BP, Candido J, Young CJ, Hong J. A Pilot Study Evaluating the Effectiveness of Biofeedback-Based Anal Strengthening Exercises in Treating Radiotherapy-Related Faecal Incontinence. Cureus 2020; 12:e11285. [PMID: 33274159 PMCID: PMC7707912 DOI: 10.7759/cureus.11285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Purpose Radiotherapy to the pelvis and especially the anal sphincters can result in long-term faecal incontinence. The aim of this study was to assess the effectiveness of biofeedback anal strengthening exercises in radiotherapy-related faecal incontinence. Methods A retrospective cohort study was performed on seven patients with radiotherapy-related faecal incontinence. Education and biofeedback based anal strengthening exercises were provided. Baseline and follow-up measurements were performed assessing anal sphincter fatigue time, resting, squeeze, and cough pressure. Continence scores and quality of life measures were assessed. Patients were followed up at five months. Results The radiotherapy target varied between prostate, uterus, and rectum. Four of the seven patients were female. Pescatori (0-10) and St Mark’s (0-10) continence scores had a median improvement of 2 (range 0-5) and 1 (range 0-8) respectively. Self-completed patient continence scores (0-10mm) had a median improvement of 2mm (1-6mm). Anal fatigue time measurements (Isotonic Fatigue Time (seconds) and Isometric Fatigue Time (Cycles)) showed a median improvement of three seconds (-4 - 36 seconds) and three seconds (-1 - 6 seconds), respectively. Resting Pressure (mmHg), Squeeze Pressure (mmHg) and Cough Pressure (mmHg) showed median improvement of 10mmHg (-10-21mmHg), 15mmHg (-16 - 100mmHg) and 21mmHg (-3 - 53mmHg), respectively. Patient-defined quality of life (QOL) measures showed a median change of 0.2 (range 0-0.5). Conclusion Patients in this pilot study with radiotherapy-related faecal incontinence had improved anal pressure metrics, continence, and QOL following biofeedback based anal strengthening exercises. These early results suggest a benefit for anal strengthening in patients undergoing pelvic radiotherapy.
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16
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Jin J, Xia W, Connolly A, Hill AG. Symptom-based scoring for haemorrhoidal disease: a systematic review. Colorectal Dis 2020; 22:1518-1527. [PMID: 32639663 DOI: 10.1111/codi.15253] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 06/23/2020] [Indexed: 12/31/2022]
Abstract
AIM Haemorrhoidal disease can severely affect a patient's quality of life. Its classification is commonly based on morphology of the degree of prolapse; however, this does not take into account the symptoms and impact on the quality of life. The aim of this systematic review was to determine the most appropriate instruments that classify the severity of disease according to symptoms. METHOD A PRISMA-compliant search was conducted in December 2019 to identify studies that described the validation of a haemorrhoidal symptom score. The measurement properties of the scoring systems were assessed based on the consensus-based standards for the selection of health status measurement instruments (COSMIN) methodology for systematic reviews for patient-reported outcome measures. RESULTS A total of 5288 articles were identified, with five articles included. Three studies developed a scoring system based on a set of core symptoms for a cohort of patients and validated the score against treatment outcomes. One study developed a disease-specific quality of life questionnaire based on symptoms to evaluate disease burden. One study combined both quality of life and symptom measures and tested measurement properties on two cohorts of patients. Only one study demonstrated satisfactory valid, reliable and responsive measurement criteria. CONCLUSION A single study demonstrated sufficient quality in measurement properties to be recommended for clinical use. Further studies in this area should utilize consensus-based standards for designing and reporting validation research to ensure that the appropriate evidence base is acquired if any further patient-reported outcome measures are to be recommended.
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Affiliation(s)
- J Jin
- Department of Surgery, South Auckland Clinical Campus, The University of Auckland, Auckland, New Zealand
| | - W Xia
- Department of Surgery, South Auckland Clinical Campus, The University of Auckland, Auckland, New Zealand
| | - A Connolly
- Department of Surgery, Counties Manukau District Health Board, Middlemore Hospital, Auckland, New Zealand
| | - A G Hill
- Department of Surgery, South Auckland Clinical Campus, The University of Auckland, Auckland, New Zealand.,Department of Surgery, Counties Manukau District Health Board, Middlemore Hospital, Auckland, New Zealand
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17
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Quality of life outcomes in patients undergoing surgery for locally recurrent rectal cancer. SEMINARS IN COLON AND RECTAL SURGERY 2020. [DOI: 10.1016/j.scrs.2020.100767] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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D'Orazio B, Geraci G, Martorana G, Sciumé C, Corbo G, Di Vita G. Fisurectomy and anoplasty with botulinum toxin injection in patients with chronic anal posterior fissure with hypertonia: a long-term evaluation. Updates Surg 2020; 73:1575-1581. [PMID: 32666478 PMCID: PMC8397652 DOI: 10.1007/s13304-020-00846-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 07/01/2020] [Indexed: 12/14/2022]
Abstract
Chronic anal fissure’s (CAF) etiopathogenesis remain unclear. CAF of the posterior commissure (CAPF) are often characterized by internal anal sphincter (IAS) hypertonia. The treatment of this disease aimed to reduce IAS hypertonia. Due to the high rate of anal incontinence after LIS, the employment of sphincter preserving surgical techniques associated to pharmacological sphincterotomy appears more sensible. The aim of our study is to evaluate the long-term results of fissurectomy and anoplasty with V–Y cutaneous flap advancement associated to 30 UI of botulinum toxin injection for CAPF with IAS hypertonia. We enrolled 45 patients undergone to fissurectomy and anoplasty with V–Y cutaneous flap advancement and 30 UI botulinum toxin injection. All patients were followed up for at least 5 years after the surgical procedure, with evaluation of anal continence, recurrence rate and MRP (Maximum resting pressure), MSP (Maximum restricting pressure), USWA (Ultrasound wave activity). All patients healed within 40 days after surgery. We observed 3 “de novo” post-operative anal incontinence cases, temporary and minor; the pre-operative ones have only temporary worsened after surgery. We reported 3 cases of recurrences, within 2 years from surgery, all healed after conservative medical therapy. At 5 year follow-up post-operative manometric findings were similar to those of healthy subjects. At 5 years after the surgical procedure, we achieved good results, and these evidences show that surgical section of the IAS is not at all necessary for the healing process of the CAPF.
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Affiliation(s)
- Beatrice D'Orazio
- General Surgery Unit, Department of Surgical, Oncological and Stomatological Sciences, University of Palermo, Via Liborio Giuffrè, 5, 90127, Palermo, Italy.,Postgraduate Medical School in General Surgery, University of Palermo, Palermo, Italy
| | - Girolamo Geraci
- General Surgery Unit, Department of Surgical, Oncological and Stomatological Sciences, University of Palermo, Via Liborio Giuffrè, 5, 90127, Palermo, Italy
| | - Guido Martorana
- General and Oncological Surgery Unit, Fondazione Istituto G. Giglio, Cefalù, Italy
| | - Carmelo Sciumé
- General Surgery Unit, Department of Surgical, Oncological and Stomatological Sciences, University of Palermo, Via Liborio Giuffrè, 5, 90127, Palermo, Italy
| | - Giovanni Corbo
- General Surgery Unit, Department of Surgical, Oncological and Stomatological Sciences, University of Palermo, Via Liborio Giuffrè, 5, 90127, Palermo, Italy.,Postgraduate Medical School in General Surgery, University of Palermo, Palermo, Italy
| | - Gaetano Di Vita
- General Surgery Unit, Department of Surgical, Oncological and Stomatological Sciences, University of Palermo, Via Liborio Giuffrè, 5, 90127, Palermo, Italy.
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19
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Bach FL, Sairally BZF, Latthe P. Effect of oestrogen therapy on faecal incontinence in postmenopausal women: a systematic review. Int Urogynecol J 2020; 31:1289-1297. [PMID: 32130466 PMCID: PMC7306041 DOI: 10.1007/s00192-020-04252-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Accepted: 01/29/2020] [Indexed: 12/15/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Faecal incontinence (FI) is prevalent in postmenopausal women. Oestrogen receptors have been identified in the anal sphincter and have been implicated in the pathogenesis and potential treatment. We sought to evaluate the literature regarding the impact of local and systemic oestrogen therapy on FI in postmenopausal women. METHODS A systematic review of all studies in postmenopausal women was performed to establish how oestrogen therapy affects FI. Eight articles were deemed eligible for inclusion following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Their quality was assessed using the Cochrane risk-of-bias tool (RoB-2) and Newcastle-Ottawa quality assessment scale. RESULTS One randomised controlled trial (RCT), two cohort studies, one observational and four cross-sectional studies were identified. The RCT showed an improvement in FI with anal oestrogen (p = 0.002), but this improvement was also observed in the placebo arm (p = 0.013) and no difference was seen between these groups. A prospective observational study demonstrated significant improvement with an oestrogen patch (p = 0.004), but had no control group. Conversely, a large prospective cohort study demonstrated an increased hazard ratio of FI with current (1.32; 95% CI, 1.20-1.45) and previous oestrogen use (1.26; 95% CI, 1.18-1.34) compared with non-users. CONCLUSION All studies had a high risk of bias and had conflicting views on the effects of oestrogen on FI in postmenopausal women. This review has identified the need for further research in this area by highlighting the paucity of good research for evidence-based practice. We believe that a further RCT of local oestrogen is mandated to draw a valid conclusion.
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Affiliation(s)
- Fiona L Bach
- Birmingham Women's Hospital, Mindelsohn Way, Birmingham, B15 2TG, UK.
- The University of Birmingham, Edgbaston Birmingham, B15 2TT, UK.
| | | | - Pallavi Latthe
- Birmingham Women's Hospital, Mindelsohn Way, Birmingham, B15 2TG, UK
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20
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Accidental Bowel Leakage Evaluation: A New Patient-Centered Validated Measure of Accidental Bowel Leakage Symptoms in Women. Dis Colon Rectum 2020; 63:668-677. [PMID: 32032195 PMCID: PMC7243684 DOI: 10.1097/dcr.0000000000001596] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Questionnaires assessing accidental bowel leakage lack important patient-centered symptoms. OBJECTIVE We aimed to create a valid measure of accidental bowel leakage symptoms. DESIGN We previously created a conceptual framework capturing patient-centered accidental bowel leakage symptoms. The framework included bowel leakage type, severity and bother, and ancillary bowel symptoms, including predictability, awareness, leakage control, emptying disorders, and discomfort. SETTINGS The study was conducted in outpatient clinics. PATIENTS Women with at least monthly accidental bowel leakage were included. INTERVENTIONS Participants completed the Accidental Bowel Leakage Evaluation at baseline and 12 and 24 weeks, as well as bowel diaries and other validated pelvic floor questionnaires. A subset completed items twice before treatment. Final item selection was based on psychometric properties and clinical importance. MAIN OUTCOME MEASURES Psychometric analyses included Cronbach α, confirmatory factor, and item response theory analyses. Construct validity was based on correlations with measures of similar constructs. RESULTS A total of 296 women completed baseline items, and 70 provided test-retest data. The cohort was predominately white (79%) and middle aged (64 ± 11 y). Confirmatory factor analyses supported the conceptual framework. The final 18-item scale demonstrated good internal consistency (Cronbach α = 0.77-0.90) and test-retest reliability (intraclass correlation = 0.80). Construct validity was demonstrated with baseline and 12- and 24-week scale scores, which correlated with the Vaizey (r = 0.52, 0.68, and 0.69), Colorectal Anal Distress Inventory (r = 0.54, 0.65, 0.71), Colorectal Anal Impact Questionnaire (r = 0.48, 0.53, 0.53), and hygiene (r = 0.39, 0.43, 0.49) and avoidance subscales scores of the adaptive index (r = 0.45, 0.44, 0.43) and average number of pad changes per day on bowel diaries (r = 0.35, 0.38, 0.31; all p < 0.001). LIMITATIONS The study was limited by nature of involving validation in a care-seeking population. CONCLUSIONS The Accidental Bowel Leakage Evaluation instrument is a reliable, patient-centered measure with good validity properties. This instrument improves on currently available measures by adding patient-important domains of predictability, awareness, control, emptying, and discomfort. See Video Abstract at http://links.lww.com/DCR/B172. EVALUACIóN DE FUGA INTESTINAL ACCIDENTAL: UNA NUEVA MEDIDA VALIDADA Y CENTRADA EN PACIENTES FEMENINOS CON SíNTOMAS DE FUGA INTESTINAL ACCIDENTAL: Los cuestionarios que evalúan la fuga intestinal accidental, carecen de síntomas centrados en el paciente.Nuestro objetivo fue crear una medida válida de síntomas de fuga intestinal accidental.Previamente creamos un marco conceptual centrado en el paciente, para capturar síntomas de fuga intestinal accidental. El marco incluía tipo de fuga intestinal, gravedad, molestia, y síntomas intestinales auxiliares, incluyendo previsibilidad, conciencia, control de fugas, trastornos de vaciado e incomodidad.Clínicas de pacientes externos.Mujeres con al menos una fuga intestinal accidental mensual.Las participantes completaron la Evaluación de Fuga Intestinal Accidental al inicio del estudio y a las 12 y 24 semanas, así como diarios intestinales y otros cuestionarios validados del piso pélvico. Un subconjunto completó los elementos dos veces antes del tratamiento. La selección final del elemento se basó en las propiedades psicométricas y la importancia clínica.Los análisis psicométricos incluyeron el Alfa de Cronbach, factor confirmatorio y análisis de la teoría de respuesta al elemento. La validez de constructo se basó en correlaciones con medidas de constructos similares.Un total de 296 mujeres completaron los elementos de referencia y 70 proporcionaron datos de test-retest. La cohorte fue predominantemente blanca (79%) y de mediana edad (64 +/- 11 años). Análisis factorial confirmatorio respaldó el marco conceptual. La escala final de 18 elementos, demostró una buena consistencia interna (Alfa de Cronbach = 0,77-0,90) y fiabilidad test-retest (correlación intraclase = 0,80). La validez de constructo se demostró con puntajes de escala de referencia de 12 y 24 semanas que se correlacionaron con Vaizey (r = 0,52, 0,68 y 0,69), Inventario de Ansiedad colorecto anal (r = 0,54, 0,65, 0,71), Cuestionarios de Impacto colorecto anal (r = 0,48, 0,53, 0,53) e higiene (r = 0,39, 0,43, 0,49), puntuaciones de subescalas de evitación del índice adaptativo (r = 0,45, 0,44, 0,43), número promedio de cambios de almohadilla por día, de los diarios intestinales (r = 0.35, 0.38, 0.31), todos p <.001.Validación de una población en busca de atención.El instrumento de Evaluación de Fuga Intestinal Accidental es una medida confiable, centrada en el paciente y con buenas propiedades de validez. Este instrumento mejora las medidas actualmente disponibles, al agregar dominios importantes para el paciente de previsibilidad, conciencia, control, vaciado e incomodidad. Consulte Video Resumen en http://links.lww.com/DCR/B172. (Traducción-Dr. Fidel Ruiz Healy).
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Eldamshety O, Kotb S, Khater A, Roshdy S, Elashry M, Zahi MS, Elkalla HMHR, Elnahas W, Farouk O, Fathi A, Senbel A, Hamed EE, Abdelwahab K, Elzahby IA, Abdallah A, Abdelaziz M, Lezoche E. Early and Late Functional Outcomes of Anal SphincterSparing Procedures With Total Mesorectal Excision for Anorectal Adenocarcinoma. Ann Coloproctol 2020; 36:148-154. [PMID: 32311866 PMCID: PMC7392569 DOI: 10.3393/ac.2018.07.19] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 07/19/2018] [Indexed: 01/07/2023] Open
Abstract
Purpose The study aims to assess the functional outcome of anal sphincter-sparing procedures (SSP) with total mesorectal excision (TME) for anorectal adenocarcinoma. Methods In a multicentric, prospective, single-group study in the period between December 2012 and November 2017, 93 patients presented with anorectal adenocarcinoma were included in the study. Sixty-nine patients underwent SSP with TME. SSP included the combined approach of transabdominal TME with intersphincteric resection (ISR) or transanal transabdominal TME. Using the per anal examination scoring system (PASS), postoperative anal function was assessed after 1 year. Results Bowel motility time was 50±19 hours. The time needed for narcotic analgesia was 54±18.8 hours. Mean hospital stay was 15.4±10.25 days. Incidence of evident fecal incontinence after ISR is 10.6% (7 of 67 cases). The PASS findings of 69 cases are as follows: extremely hypotonic 8.6% (6 cases), slightly hypotonic 26.1% (18 cases), normal tone 58% (40 cases), slightly stenotic 3 cases (4.3%), or occluded 2.9% (2 cases). Urinary dysfunction occurred in 1 case (1.4%). Temporary diversion was performed in 61 patients (87.1%). Conclusion Sphincter preservation with TME for anorectal adenocarcinoma helps avoid permanent stoma and provides reasonable functional outcomes. PASS is a new application for postoperative assessment of anal function.
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Affiliation(s)
- Osama Eldamshety
- surgical oncology, oncology centre, Mansoura university, Elmansoura, Egypt
| | - Sherif Kotb
- Surgery department, Oncology Centre of Mansoura University, Mansoura, Egypt
| | - Ashraf Khater
- Surgery department, Oncology Centre of Mansoura University, Mansoura, Egypt
| | - Sameh Roshdy
- Surgery department, Oncology Centre of Mansoura University, Mansoura, Egypt
| | - Mohamed Elashry
- Department of clinical oncology and nuclear medicine, Mansoura University, Mansoura, Mansoura, Egypt
| | - Mohamed S Zahi
- Department of clinical oncology and nuclear medicine, Mansoura University, Mansoura, Mansoura, Egypt
| | | | - Waleed Elnahas
- Surgery department, Oncology Centre of Mansoura University, Mansoura, Egypt
| | - Omar Farouk
- Surgery department, Oncology Centre of Mansoura University, Mansoura, Egypt
| | - Adel Fathi
- Surgery department, Oncology Centre of Mansoura University, Mansoura, Egypt
| | - Ahmed Senbel
- Surgery department, Oncology Centre of Mansoura University, Mansoura, Egypt
| | - Emad-Eldeen Hamed
- Surgery department, Oncology Centre of Mansoura University, Mansoura, Egypt
| | - Khaled Abdelwahab
- Surgery department, Oncology Centre of Mansoura University, Mansoura, Egypt
| | | | - Ahmed Abdallah
- Surgery department, Oncology Centre of Mansoura University, Mansoura, Egypt
| | - Mahmoud Abdelaziz
- Surgery department, Oncology Centre of Mansoura University, Mansoura, Egypt
| | - Emanuele Lezoche
- Surgery department, Policlinico Umberto primo, Sapienza University of Rome, Rome, Italy
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Fritel X, Gachon B, Saurel‐Cubizolles MJ, Annesi‐Maesano I, Bernard JY, Botton J, Charles MA, Dargent‐Molina P, de Lauzon‐Guillain B, Ducimetière P, de Agostini M, Foliguet B, Forhan A, Fritel X, Germa A, Goua V, Hankard R, Heude B, Kaminski M, Larroque B, Lelong N, Lepeule J, Magnin G, Marchand L, Nabet C, Pierre F, Slama R, Saurel‐Cubizolles MJ, Schweitzer M, Thiebaugeorges O. Postpartum psychological distress associated with anal incontinence in the EDEN mother–child cohort. BJOG 2020; 127:619-627. [DOI: 10.1111/1471-0528.16075] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2019] [Indexed: 12/26/2022]
Affiliation(s)
- X Fritel
- Gynaecology and Obstetrics Department University Hospital of Poitiers Poitiers France
| | - B Gachon
- Gynaecology and Obstetrics Department University Hospital of Poitiers Poitiers France
| | - MJ Saurel‐Cubizolles
- Epidemiology and Statistics Research Centre/CRESS‐EPOPé INSERM INRA Université de Paris Paris France
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Stuart A, Ignell C, Örnö AK. Comparison of transperineal and endoanal ultrasound in detecting residual obstetric anal sphincter injury. Acta Obstet Gynecol Scand 2019; 98:1624-1631. [PMID: 31378920 DOI: 10.1111/aogs.13701] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 05/17/2019] [Accepted: 07/16/2019] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Endoanal ultrasound is considered the gold standard when assessing the obstetric anal sphincter complex. Due to its relative intrusiveness and economic cost, other ultrasound modalities are on the rise, such as transperineal ultrasound with a convex probe. The aim of our study was to evaluate the agreement between endoanal ultrasound scores (EAUS score) and transperineal ultrasound scores (TPUS score) in assessing residual obstetric anal sphincter defects. MATERIAL AND METHODS Fifty-nine women were examined 6 months after primary suturing of obstetric anal sphincter injury with two ultrasound modalities. A standardized scoring system analyzing the length, depth and radial extent of both the external (EAS) and internal (IAS) sphincter was used. Wexner fecal incontinence score was used to assess the patients' symptoms. RESULTS Transperineal ultrasound scores score showed a strong significant correlation with EAUS score during both pelvic floor relaxation and contraction: Spearman's rho [rs ] = 0.74, P < 0.001, and rs = 0.77, P < 0.001, respectively. For both EAS and IAS, significant correlations were found for all parameters, that is, length, depth and angle between both EAUS and TPUS. A statistically significant correlation was found between EAUS score and Wexner score (rs = 0.36, P = 0.005). A significant correlation between the EAS-EAUS score (rs = 0.36, P = 0.005) and Wexner score was found, but no significance was found between IAS-EAUS score and Wexner score (rs = 0.22, P = 0.097). Significant correlations were found for Wexner score and TPUS score in resting state (rs = 0.36, P = 0.01) and contracting state (rs = 0.28, P < 0.05), and between Wexner score and EAS-TPUS score in resting state (rs = 0.32, P = 0.02). CONCLUSIONS The results indicated a strong agreement between endoanal and transperineal ultrasound in assessing residual obstetric anal sphincter defects 6 months after primary suturing. Furthermore, a weak significant correlation was found between the ultrasound scores and the patients' Wexner fecal incontinence score.
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Affiliation(s)
- Andrea Stuart
- Department of Obstetrics and Gynecology, Helsingborg Hospital, Helsingborg, Sweden
| | - Claes Ignell
- Department of Obstetrics and Gynecology, Helsingborg Hospital, Helsingborg, Sweden.,Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Ann-Kristin Örnö
- Department of Obstetrics and Gynecology, Sahlgrenska University Hospital, Göteborg, Sweden
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24
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Acar T, Acar N, Güngör F, Kamer E, Güngör H, Candan MS, Bağ H, Tarcan E, Dilek ON, Haciyanli M. Treatment of chronic anal fissure: Is open lateral internal sphincterotomy (LIS) a safe and adequate option? Asian J Surg 2019; 42:628-633. [PMID: 30366766 DOI: 10.1016/j.asjsur.2018.10.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 09/04/2018] [Accepted: 10/02/2018] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Anal fissure which is defined as a longitudinal tear in anoderm under the dentate line is one of the most common benign diseases of anorectal area, and due to the severe pain during the defecation and emotional stress that it causes may reduce people's quality of life. There are several treatment methods such as medical substances and surgical procedures. In this retrospective study, we aimed to evaluate the safe and adequate option of lateral internal sphincterotomy (LIS) in chronic anal fissure treatment. METHODS This study is a retrospective study in which 417 patients who were treated for chronic anal fissure were included. RESULTS Of 417 patients included in the study, 228 (54.7%) were female and the mean ± SD age was 36.1 ± 8.96 years (ranging from 17 to 73 years). Major complaints of patients; pain, bleeding, constipation, pruritus, perianal discharge. Recurrence occurred in 15 patients (3.6%) (12 males, three females) and eight patients (1.9%) developed incontinence (four with gas, four with soiling and seven females, one male). The complaints of all patients with gas incontinence and a patient with fluid incontinence regressed, whereas three patients had permanent fluid incontinence. CONCLUSION LIS is still the gold standard for the treatment of chronic anal fissure when the physicians would like to avoid recurrence and obtain the best pain relief.
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Affiliation(s)
- Turan Acar
- İzmir Katip Çelebi University, Atatürk Training and Research Hospital, Department of General Surgery, Basın Sitesi, İzmir, Turkey.
| | - Nihan Acar
- İzmir Katip Çelebi University, Atatürk Training and Research Hospital, Department of General Surgery, Basın Sitesi, İzmir, Turkey.
| | - Feyyaz Güngör
- İzmir Katip Çelebi University, Atatürk Training and Research Hospital, Department of General Surgery, Basın Sitesi, İzmir, Turkey.
| | - Erdinç Kamer
- İzmir Katip Çelebi University, Atatürk Training and Research Hospital, Department of General Surgery, Basın Sitesi, İzmir, Turkey.
| | - Hilmi Güngör
- İzmir Katip Çelebi University, Atatürk Training and Research Hospital, Department of General Surgery, Basın Sitesi, İzmir, Turkey.
| | - Mehmet Sercan Candan
- İzmir Katip Çelebi University, Atatürk Training and Research Hospital, Department of General Surgery, Basın Sitesi, İzmir, Turkey.
| | - Halis Bağ
- İzmir Katip Çelebi University, Atatürk Training and Research Hospital, Department of General Surgery, Basın Sitesi, İzmir, Turkey.
| | - Ercüment Tarcan
- İzmir Katip Çelebi University, Atatürk Training and Research Hospital, Department of General Surgery, Basın Sitesi, İzmir, Turkey.
| | - Osman Nuri Dilek
- İzmir Katip Çelebi University, Atatürk Training and Research Hospital, Department of General Surgery, Basın Sitesi, İzmir, Turkey.
| | - Mehmet Haciyanli
- İzmir Katip Çelebi University, Atatürk Training and Research Hospital, Department of General Surgery, Basın Sitesi, İzmir, Turkey.
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A systematic review of non-invasive modalities used to identify women with anal incontinence symptoms after childbirth. Int Urogynecol J 2018; 30:869-879. [DOI: 10.1007/s00192-018-3819-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 11/08/2018] [Indexed: 12/18/2022]
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Cassis C, Giarenis I, Mukhopadhyay S, Morris E. Mode of delivery following an OASIS and caesarean section rates. Eur J Obstet Gynecol Reprod Biol 2018; 230:28-31. [PMID: 30237137 DOI: 10.1016/j.ejogrb.2018.09.020] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 07/23/2018] [Accepted: 09/11/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVES While the rate of obstetric anal sphincter injury (OASIS) is increasing, there is a lack of evidence on how best to advise women on mode of delivery (MOD) afterwards. The objectives of this study were to assess the clinical value of bowel symptoms, endoanal ultrasound and anorectal manometry in the management of pregnancies after an OASIS and evaluate the performance of different algorithms. STUDY DESIGN This was a retrospective analysis of prospectively collected data in a university hospital perineal clinic. Women with OASIS undergoing endoanal ultrasound scan (EAUS) and anorectal manometry (AM) were included in this study (all women with an OASIS, except the asymptomatic 3a tears). A number of published algorithms were theoretically applied in this cohort to define recommended MOD after an OASIS. RESULTS Out of the 233 women included in the study, 51 (21.9%) were symptomatic, 141 (60.5%) had persistent sphincter defects on EAUS and 124 (53.2%) had abnormal AM. One asymptomatic and five symptomatic women were found to have isolated internal anal sphincter (IAS) defects without external anal sphincter (EAS) defects. There were no women with low resting pressure and normal incremental squeeze pressure. The application of the algorithm requiring only one abnormal investigation to be recommended caesarean would have led to an 81.5% caesarean rate. If women with symptoms of anal incontinence or abnormal investigations would be advised for caesarean the rate would be 85.0%. Using the local protocol where symptomatic women only needed one of the two investigations to be abnormal but asymptomatic women were required to have both investigations being abnormal, 94 were considered for caesarean (40.3%). CONCLUSION There is a wide range in the number of patients recommended to have caesarean section after an OASIS, depending on the used criteria and management algorithms. There is minimal additional information gained from identifying internal anal sphincter defects and measuring low resting pressures at manometry.
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Affiliation(s)
| | | | | | - Edward Morris
- Norfolk and Norwich University Hospital, United Kingdom
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Fradet-Menard C, Deparis J, Gachon B, Sichitiu J, Pierre F, Fritel X, Desseauve D. Obstetrical anal sphincter injuries and symptoms after subsequent deliveries: A 60 patient study. Eur J Obstet Gynecol Reprod Biol 2018; 226:40-46. [DOI: 10.1016/j.ejogrb.2018.05.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Revised: 04/22/2018] [Accepted: 05/08/2018] [Indexed: 11/29/2022]
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Development of Perianal Sepsis Index (PASI) for assessing quality of life in chronic perianal sepsis. Eur Surg 2018. [DOI: 10.1007/s10353-018-0543-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Witte M, Schwandner F, Klar E. Before and after Anorectal Surgery: Which Information Is Needed from the Functional Laboratory? Visc Med 2018; 34:128-133. [PMID: 29888242 DOI: 10.1159/000486693] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Background Anorectal surgery covers a wide spectrum of surgery. Diagnostic workup of anorectal disease is based on clinical examination with basic functional tests followed by more elaborate diagnostic tests. Since the incidence of anorectal disorders increases with age, more patients will present in outpatient clinics, thus underlining the relevance of this topic. Methods A PubMed literature search was performed using the terms 'anal incontinence', 'anal and rectal surgery', 'functional diagnostics', and combinations of these terms. No restriction regarding publication year or publication type was applied but randomized trials, 'metanalyses', or guidelines were ranked higher. Only articles in English or German were included. Results The diagnostic value of digital rectal examination, anal manometry and endosonography, the water holding procedure, contrast enema, and incontinence scores is summarized. Conclusion The article focusses on basic clinical and functional diagnostic tests which can be easily applied in the pre- and postoperative setting to evaluate the postoperative outcome.
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Affiliation(s)
- Maria Witte
- Department of General, Thoracic-, Vascular and Transplant Surgery, University Medical Department Rostock, Rostock, Germany
| | - Frank Schwandner
- Department of General, Thoracic-, Vascular and Transplant Surgery, University Medical Department Rostock, Rostock, Germany
| | - Ernst Klar
- Department of General, Thoracic-, Vascular and Transplant Surgery, University Medical Department Rostock, Rostock, Germany
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Operative vaginal delivery in case of persistent occiput posterior position after manual rotation failure: a 6-month follow-up on pelvic floor function. Arch Gynecol Obstet 2018; 298:111-120. [PMID: 29785548 DOI: 10.1007/s00404-018-4794-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 05/16/2018] [Indexed: 01/04/2023]
Abstract
PURPOSE To compare the short- and long-term perineal consequences (at 6 months postpartum) and short-term neonatal consequences of instrumental rotation (IR) to those induced by assisted delivery (AD) in the occiput posterior (OP) position, in case of manual rotation failure. METHODS A prospective observational cohort study; tertiary referral hospital including all women presenting with persistent OP position who delivered vaginally after manual rotation failure with attempted IR or AD in OP position from September 2015 to October 2016. Maternal and neonatal outcomes of all attempted IR deliveries were compared with OP operative vaginal deliveries. Main outcomes measured were pelvic floor function at 6 months postpartum including Wexner score for anal incontinence and ICIQ-FLUTS for urinary symptoms. Perineal morbidity comprised severe perineal tears, corresponding to third and fourth degree lacerations. Fetal morbidity parameters comprised low neonatal Apgar scores, acidaemia, major and minor fetal injuries and neonatal intensive care unit admissions. RESULTS Among 5265 women, 495 presented with persistent OP positions (9.4%) and 111 delivered after manual rotation failure followed by AD delivery: 58 in the IR group and 53 in the AD in OP group. The incidence of anal sphincter injuries was significantly reduced after IR attempt (1.7% vs. 24.5%; p < 0.001) without increasing neonatal morbidity. At 6 months postpartum, AD in OP position was associated with higher rate of anal incontinence (30% vs. 5.5%, p = 0.001) and with more urinary symptoms, dyspareunia and perineal pain. CONCLUSIONS OP operative deliveries are associated with significant perineal morbidity and pelvic floor dysfunction at 6 months postpartum.
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A Scoping Study of Psychosocial Factors in Women Diagnosed With and/or Treated for Pelvic Organ Prolapse. Female Pelvic Med Reconstr Surg 2018; 26:327-348. [PMID: 29509647 DOI: 10.1097/spv.0000000000000578] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE Pelvic organ prolapse (POP) is prevalent and can impact women's physical and psychosocial health. To develop interventions that support this population, an understanding of the state of research on psychosocial factors related to POP is essential. We conducted a scoping study focused on the psychosocial experience of women with POP. The purpose of this review was to (1) inventory and describe the current state of knowledge of the psychosocial experience of women with POP, (2) identify gaps in knowledge, and (3) identify targets for future research. METHOD Electronic databases PsycINFO, PubMed, EMBASE, and CINAHL were searched through November 1, 2017. RESULTS Of 524 titles reviewed, 103 articles met all inclusion criteria. Articles were grouped by the disease period (ie, prediagnosis, diagnosis/preintervention, intervention, follow-up, and mixed) and psychosocial factors. Most articles (n = 73) focused on women undergoing intervention. Articles focusing on the preintervention period was the next largest category (n = 14). Follow-up after intervention (n = 8) and samples of mixed disease periods (n = 7) were less common. One article focused on women before diagnosis. Articles focused on quality of life (QOL; n = 79), sexual function (n = 51), satisfaction (n = 16), body image (n = 13), psychological distress (n = 4), and knowledge (n = 3). CONCLUSIONS Research on the psychosocial experience of POP has largely focused on changes in QOL and sexual function. Future research should target emotional experience of women with POP; relationships among QOL, psychological distress, body image, and sexual function; and psychosocial factors related to treatment outcomes.
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Cerdán Santacruz C, Santos Rancaño R, Vigara García M, Fernández Pérez C, Ortega López M, Cerdán Miguel J. Prevalence of anal incontinence in a working population within a healthcare environment. Scand J Gastroenterol 2017; 52:1340-1347. [PMID: 28918677 DOI: 10.1080/00365521.2017.1378713] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVES Anal incontinence is a devastating affliction with several considerations that make it difficult to define in terms of epidemiology with good precision. The aim of the present work is to study the prevalence of an important disorder such as anal incontinence in a healthy working population within a sanitary environment. MATERIAL AND METHODS A cluster of easy understanding and filling inquiry forms are distributed to 910 apparently healthy individuals at our hospital. This questionnaires include filiation data, passed medical history, presence or not of Incontinence and other symptoms such as urgency. The Cleveland Clinic Incontinence Score is also registered. RESULTS Anal incontinence is present in a 21.2% of subjects when considered in any of it forms (flatus, liquid or solid faeces). A Clevleand Clinic Incontinence Score higher than 6 was obtained in a 7.3% of the sample and higher than 10 in 1.2%. No gender predominance has been identified. A slightly higher severity is recognised with increasing age. Obstetric and anal surgical background are the only related factors identified in the studied sample. CONCLUSIONS Faecal incontinence is a high prevalent affliction, even among apparently healthy population. Considering the aetiologic factors that have been established, prevention during obstetric and anal surgical procedures is absolutely mandatory.
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Affiliation(s)
| | - Rocío Santos Rancaño
- b Department of General Surgery , Hospital Comarcal de Melilla , Melilla , Spain
| | - Marta Vigara García
- c Department of Geriatrics and Gerontology , Hospital Clinico San Carlos , Madrid , Spain
| | - Cristina Fernández Pérez
- d Clinical Research and Methodology Unit , Hospital Clínico San Carlos, Medical School, Universidad Complutense, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC) , Madrid , Spain
| | - Mario Ortega López
- e Colorectal Surgery Department , Fundación Jiménez Díaz , Madrid , Spain
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Young CJ, Zahid A, Koh CE, Young JM. Hypothesized summative anal physiology score correlates but poorly predicts incontinence severity. World J Gastroenterol 2017; 23:5732-5738. [PMID: 28883698 PMCID: PMC5569287 DOI: 10.3748/wjg.v23.i31.5732] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 06/14/2017] [Accepted: 07/12/2017] [Indexed: 02/07/2023] Open
Abstract
AIM To explore the relationship between such a construct and an existing continence score.
METHODS A retrospective study of incontinent patients who underwent anal physiology (AP) was performed. AP results and Cleveland Clinic Continence Scores (CCCS) were extracted. An anal physiology score (APS) was developed using maximum resting pressures (MRP), anal canal length (ACL), internal and external sphincter defects and pudendal terminal motor latency. Univariate associations between each variable, APS and CCCS were assessed. Multiple regression analyses were performed.
RESULTS Of 508 (419 women) patients, 311 had both APS and CCCS measured. Average MRP was 51 mmHg (SD 23.2 mmHg) for men and 39 mmHg (19.2 mmHg) for women. Functional ACL was 1.7 cm for men and 0.7 cm for women. Univariate analyses demonstrated significant associations between CCCS and MRP (P = 0.0002), ACL (P = 0.0006) and pudendal neuropathy (P < 0.0001). The association between APS and CCCS was significant (P < 0.0001) but accounted for only 9.2% of the variability in CCCS. Multiple regression showed that the variables most useful in predicting CCCS were external sphincter defect, pudendal neuropathy and previous pelvic surgery, but only improving the scores predictive ability to 12.5%.
CONCLUSION This study shows that the ability of AP tests to predict continence scores improves when considered collectively, but that a constructed summation model before and after multiple regression is poor at predicting the variability in continence scores.
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Affiliation(s)
- Christopher J Young
- Department of Colorectal Surgery, University of Sydney, Sydney, NSW 2042, Australia
- RPAH Medical Centre, Sydney, NSW 2042, Australia
- Discipline of Surgery, University of Sydney, Sydney, NSW 2042, Australia
| | - Assad Zahid
- Department of Colorectal Surgery, University of Sydney, Sydney, NSW 2042, Australia
- Discipline of Surgery, University of Sydney, Sydney, NSW 2042, Australia
| | - Cherry E Koh
- Department of Colorectal Surgery, University of Sydney, Sydney, NSW 2042, Australia
- Surgical Outcome Research Centre (SOuRCe), Royal Prince Alfred Hospital, University of Sydney, Sydney, NSW 2042, Australia
| | - Jane M Young
- Surgical Outcome Research Centre (SOuRCe), Royal Prince Alfred Hospital, University of Sydney, Sydney, NSW 2042, Australia
- School of Public health, University of Sydney, Sydney, NSW 2006, Australia
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Does a Defunctioning Stoma Impair Anorectal Function After Low Anterior Resection of the Rectum for Cancer? A 12-Year Follow-up of a Randomized Multicenter Trial. Dis Colon Rectum 2017; 60:800-806. [PMID: 28682965 DOI: 10.1097/dcr.0000000000000818] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Anorectal function after low anterior resection of the rectum for cancer is often impaired, and long-term outcome has not frequently been reported. OBJECTIVE We evaluated anorectal function 12 years after rectal resection with regard to whether patients had a defunctioning temporary stoma at the initial rectal resection. DESIGN An exploratory cross-sectional investigation of a previously randomized study population. SETTINGS Twenty-one Swedish hospitals performing rectal cancer surgery during a 5-year period participated in the trial. PATIENTS Patients operated on with low anterior resection for cancer were included. INTERVENTIONS Patients were randomly assigned to receive or not receive a temporary defunctioning stoma. MAIN OUTCOME MEASURES We evaluated anorectal function 12 years after low anterior resection in patients who were initially randomly assigned to temporary stoma or not, by means of using the low anterior resection syndrome score questionnaire, which assesses incontinence for flatus, incontinence for liquid stools, defecation frequency, clustering, and urgency. Self-perceived health status was evaluated by the EQ-5D-3L questionnaire. RESULTS Eighty-nine percent (87/98) of the patients responded to the questionnaires, including 46 with and 41 without an initial temporary stoma. Patient demography was comparable between the groups. No differences regarding major, minor, and no low anterior resection syndrome categories were found between the groups. The stoma group had increased incontinence for flatus (p = 0.03) and liquid stools (p = 0.005) and worse overall low anterior resection syndrome score (p = 0.04) but no differences regarding frequency, clustering, and urgency. LIMITATIONS The study was limited by its sample size (n = 98) based on a previously randomized trial population (n = 234). CONCLUSIONS After low anterior resection for cancer, the incidence of the categories major, minor, and no low anterior resection syndrome were comparable in the stoma and the no-stoma groups. Incontinence for flatus and liquid stools was more commonly reported by patients who were randomly assigned to temporary stoma, as compared with those without, which may indicate an association between temporary stoma and impaired anorectal function. See Video Abstract at http://links.lww.com/DCR/A413.
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Keane C, Wells C, O'Grady G, Bissett IP. Defining low anterior resection syndrome: a systematic review of the literature. Colorectal Dis 2017; 19:713-722. [PMID: 28612460 DOI: 10.1111/codi.13767] [Citation(s) in RCA: 135] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Accepted: 03/29/2017] [Indexed: 12/13/2022]
Abstract
AIM There is increasing awareness of the poor functional outcome suffered by many patients after sphincter-preserving rectal resection, termed 'low anterior resection syndrome' (LARS). There is no consensus definition of LARS and varying instruments have been employed to measure functional outcome, complicating research into prevalence, contributing factors and potential therapies. We therefore aimed to describe the instruments and outcome measures used in studies of bowel dysfunction after low anterior resection and identify major themes used in the assessment of LARS. METHOD A systematic review of the literature was performed for studies published between 1986 and 2016. The instruments and outcome measures used to report bowel function after low anterior resection were extracted and their frequency of use calculated. RESULTS The search revealed 128 eligible studies. These employed 18 instruments, over 30 symptoms, and follow-up time periods from 4 weeks to 14.6 years. The most frequent follow-up period was 12 months (48%). The most frequently reported outcomes were incontinence (97%), stool frequency (80%), urgency (67%), evacuatory dysfunction (47%), gas-stool discrimination (34%) and a measure of quality of life (80%). Faecal incontinence scoring systems were used frequently. The LARS score and the Bowel Function Instrument (BFI) were used in only nine studies. CONCLUSION LARS is common, but there is substantial variation in the reporting of functional outcomes after low anterior resection. Most studies have focused on incontinence, omitting other symptoms that correlate with patients' quality of life. To improve and standardize research into LARS, a consensus definition should be developed, and these findings should inform this goal.
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Affiliation(s)
- C Keane
- Department of Surgery, University of Auckland, Auckland, New Zealand
| | - C Wells
- Department of Surgery, University of Auckland, Auckland, New Zealand
| | - G O'Grady
- Department of Surgery, University of Auckland, Auckland, New Zealand
| | - I P Bissett
- Department of Surgery, University of Auckland, Auckland, New Zealand.,Department of Surgery, Auckland City Hospital, Auckland, New Zealand
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Han X, Xu J, Qiu H, Lin G. A Novel Curative Treatment Strategy for Patients with Lower Grade Rectal Gastrointestinal Stromal Tumor: Chemoreduction Combined with Transanal Endoscopic Microsurgery. J Laparoendosc Adv Surg Tech A 2017; 27:579-585. [PMID: 28358587 DOI: 10.1089/lap.2017.0051] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Affiliation(s)
- Xianlin Han
- Department of General Surgery, Peking Union Medical College Hospital, Beijing, China
| | - Jing Xu
- Peking Union Medical College, Beijing, China
| | - Huizhong Qiu
- Department of General Surgery, Peking Union Medical College Hospital, Beijing, China
| | - Guole Lin
- Department of General Surgery, Peking Union Medical College Hospital, Beijing, China
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A Cross-Sectional Review of Reporting Variation in Postoperative Bowel Dysfunction After Rectal Cancer Surgery. Dis Colon Rectum 2017; 60:240-247. [PMID: 28059921 DOI: 10.1097/dcr.0000000000000649] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Postoperative bowel dysfunction affects quality of life after sphincter-preserving rectal cancer surgery, but the extent of the problem is not clearly defined because of inconsistent outcome measures used to characterize the condition. OBJECTIVE The purpose of this study was to assess variation in the reporting of postoperative bowel dysfunction and to make recommendations for standardization in future studies. If possible, a quantitative synthesis of bowel dysfunction symptoms was planned. DATA SOURCES MEDLINE and EMBASE databases, as well as the Cochrane Library, were queried systematically between 2004 and 2015. STUDY SELECTION The studies selected reported at least 1 component of bowel dysfunction after resection of rectal cancer. MAIN OUTCOME MEASURES The main outcome measures were reporting, measurement, and definition of postoperative bowel dysfunction. RESULTS Of 5428 studies identified, 234 met inclusion criteria. Widely reported components of bowel dysfunction were incontinence to stool (227/234 (97.0%)), frequency (168/234 (71.8%)), and incontinence to flatus (158/234 (67.5%)). Urgency and stool clustering were reported less commonly, with rates of 106 (45.3%) of 234 and 61 (26.1%) of 234. Bowel dysfunction measured as a primary outcome was associated with better reporting (OR = 3.49 (95% CI, 1.99-6.23); p < 0.001). Less than half of the outcomes were assessed using a dedicated research tool (337/720 (46.8%)), and the remaining descriptive measures were infrequently defined (56/383 (14.6%)). LIMITATIONS Heterogeneity in the reporting, measurement, and definition of postoperative bowel dysfunction precluded pooling of results and limited interpretation. CONCLUSIONS Considerable variation exists in the reporting, measurement, and definition of postoperative bowel dysfunction. These inconsistencies preclude reliable estimates of incidence and meta-analysis. A broadly accepted outcome measure may address this deficit in future studies.
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De Nardi P, Testoni SGG, Corsetti M, Andreoletti H, Giollo P, Passaretti S, Testoni PA. Manometric evaluation of anorectal function in patients treated with neoadjuvant chemoradiotherapy and total mesorectal excision for rectal cancer. Dig Liver Dis 2017; 49:91-97. [PMID: 27720700 DOI: 10.1016/j.dld.2016.09.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Revised: 08/22/2016] [Accepted: 09/14/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND An altered anorectal function is reported after chemoradiotherapy (CRT) and surgery for rectal cancer. AIM The aim of this study was to clarify the relative contribution of neoadjuvant chemoradiation and surgical resection on the impairment of anorectal function as evaluated by anorectal manometry. METHODS Thirty-nine patients with rectal cancer, who underwent neoadjuvant CRT and laparoscopic rectal resection, were evaluated with the Pescatori Faecal Incontinence score, and with anorectal manometry: before neoadjuvant therapy (T0), after neoadjuvant therapy and before surgery (T1), 12 months after stoma closure (T2). RESULTS Resting and/or maximum squeeze pressure and/or volume thresholds for urgency were below the normal values in 12 (30%) patients at baseline. After CRT the mean resting pressure significantly decreased (p=0.007). Surgery determined a significantly decrease of the resting pressure (p=0.001), of the maximum squeeze pressure (p=0.001) and of the volume threshold for urgency (p=0.001). Impairment of continence was reported by 5, 11 and 18 patients at T0, T1 and T2, with a mean incontinence score of 3, 3.8 and 3.9 respectively. CONCLUSIONS CRT is detrimental to the function of the internal anal sphincter. Rectal resection significantly affects both internal and external anal sphincter function and the maximum tolerated volume of the neo-rectum, particularly in patients with low rectal cancer, significantly impairing anal continence.
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Affiliation(s)
- Paola De Nardi
- Gastrointestinal Surgery, San Raffaele Scientific Institute, Milan, Italy.
| | | | - Maura Corsetti
- National Institute for Health Research, Nottingham Digestive Diseases Biomedical Research Unit, Nottingham University Hospitals NHS Trust, University of Nottingham, Nottingham, UK
| | - Hulda Andreoletti
- Service de Anesthésiologie,Etablissements Hospitaliers du Nord Vaudois, Yverdon-les-Bain, Switzerland
| | - Patrizia Giollo
- Gastroenterology Division, San Raffaele Scientific Institute, Milan, Italy
| | - Sandro Passaretti
- Gastroenterology Division, San Raffaele Scientific Institute, Milan, Italy
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Robot-Assisted Sacrocolporectopexy for Multicompartment Prolapse of the Pelvic Floor: A Prospective Cohort Study Evaluating Functional and Sexual Outcome. Dis Colon Rectum 2016; 59:968-74. [PMID: 27602928 DOI: 10.1097/dcr.0000000000000669] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Pelvic floor disorders are a major public health issue. For female genital prolapse, sacrocolpopexy is the gold standard. Laparoscopic ventral mesh rectopexy is a relatively new and promising technique correcting rectal prolapse. There is no literature combining the 2 robotically assisted techniques. OBJECTIVE This study was designed to evaluate the safety, quality of life, and functional and sexual outcomes of robot-assisted sacrocolporectopexy for multicompartment prolapse of the pelvic floor. DESIGN This was a prospective, observational cohort study. SETTINGS The study was conducted in a tertiary care setting. PATIENTS All sexually active patients undergoing robot-assisted sacrocolporectopexy at our institution between 2012 and 2014 were included. INTERVENTION Robot-assisted sacrocolporectopexy was the study intervention. MAIN OUTCOME MEASURES Preoperative and postoperative (12 months) questionnaires using the Urinary Distress Inventory, Pescatori Incontinence Scale, Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire, and Pelvic Floor Impact Questionnaire were completed. In addition Wexner and Vaizey incontinence scores and the Wexner constipation score were recorded postoperatively. RESULTS Fifty-one patients underwent robot-assisted sacrocolporectopexy (median follow-up, 12.5 months). The simplified Pelvic Organ Prolapse Quantification improved significantly (p < 0.0005) for all 4 of the anatomic landmarks. Both median fecal (preoperative and postoperative Pescatori 4 vs 3, p = 0.002) and urinary incontinence scores (Urinary Distress Inventory, 27.8 vs 22.2; p < 0.0005) improved significantly at 12 months. Postoperatively median Wexner (3) and Vaizey incontinence (6) and Wexner Constipation (7) scores were noted. A positive effect on sexual function (Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire score 31.8 vs 35.9; p = 0.002) and quality of life for each compartment (p < 0.0005) was observed. One patient (2%) developed mesh erosion. No multicompartment recurrences were detected. LIMITATIONS This was a observational study with a limited follow-up, no control group, and no preoperatively validated constipation score. CONCLUSIONS Robot-assisted sacrocolporectopexy is a safe and effective technique for multicompartment prolapse in terms of functional outcome, quality of life, and sexual function.
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Abstract
INTRODUCTION Objectively evaluating the lack of bowel control (fecal incontinence) continues to be a challenge. Many have attempted to measure the severity of fecal incontinence and to evaluate its impact on the quality of life by developing standardized scoring systems. Some of these systems have been validated but none have achieved widespread use and all have limitations in evaluating pediatric patients. METHODS A review of the literature was performed looking for validated scoring systems of fecal incontinence that are currently used for either adult or pediatric patients. The identified scoring systems were then critically analyzed and their applicability for managing fecally incontinent children considered. RESULTS Thirteen of the most frequently used fecal incontinence scoring systems were selected (6 for adults and 7 for children). Quality of life questionnaires were excluded not only because of their length and complexity, but mostly because they do not accurately reflect a measurement of bowel control. Our analysis revealed that all pediatric scoring systems require some degree of interpretation as they included at least one subjective parameter. These unverifiable subjective parameters were: "sensation of rectal fullness", "sphincter squeeze", and "anal shape". Equally problematic, the pediatric systems frequently focused on factors unrelated to fecal continence such as "frequency of bowel movements", "rectal prolapse", "abdominal pain", "blood in the stool", "leakage of urine", "diarrhea", and "constipation". The most objective system found from our review is the Krickenbeck system, which focuses upon two objective factors. Those two factors are the absence of voluntary bowel movements and the presence of soiling in the underwear. The major weakness of the Krickenbeck system is that it does not allow for reassessment after medical or surgical interventions. In this paper, we propose a modification of the Krickenbeck system that allows for such an assessment to be applied to those patients who are able to achieve voluntary bowel movements with the aid of laxatives or constipating agents. CONCLUSIONS Most scoring systems are flawed because they invite bias and interpretation due to their subjective nature, while systems focused on measuring quality of life do not address the fundamental issue of bowel control. The Krickenbeck score seems to be the most applicable and objective method of evaluating bowel control in pediatric patients that may be more useful when modified to assess patients after medical intervention.
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Restivo A, Zorcolo L, D'Alia G, Cocco F, Cossu A, Scintu F, Casula G. Risk of complications and long-term functional alterations after local excision of rectal tumors with transanal endoscopic microsurgery (TEM). Int J Colorectal Dis 2016; 31:257-66. [PMID: 26298182 DOI: 10.1007/s00384-015-2371-y] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/13/2015] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Transanal endoscopic microsurgery (TEM) is a consolidated technique for the excision of rectal tumors. However, many aspects relating to its morbidity, risk of functional alterations, and therapeutic outcomes are still unclear. The aim of this study was to assess the rate of morbidity and fecal incontinence after TEM, and to identify associated risk factors. METHODS We prospectively recorded the clinical data of 157 patients who underwent TEM from 1996 to 2013. Among these, 89 patients answered a questionnaire for the assessment of fecal continence at a median follow-up time of 40 months. RESULTS Intraoperative and postoperative TEM complication rates were 3.8 and 20.4%. The mortality rate was 0.6%. A distance from the anal verge of more than 6 cm correlated with a higher risk of perforation, while patients with cancer were more likely to have postoperative bleeding. Incontinence was reported by 32 (36%) patients, of which 7 (8%) experienced transitory symptoms only, while 25 (28%) reported persistent symptoms. We found a correlation between patients receiving preoperative radiotherapy (RT) and the development of fecal incontinence. The recurrence rate was 3% (1/32) in pT1, 80% (4/5) in pT2, and 100% (1/1) in pT3. After radiotherapy, 7% (1/9) showed a good response (pT0-1), and 18% (2/7) showed no response (pT2-3). CONCLUSIONS TEM is associated with low morbidity but the risk of developing functional alterations is not negligible and should be discussed with the patient before the operation. Good oncological outcomes are possible for early invasive cancers and for selected advanced cancers following a good response to preoperative RT.
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Affiliation(s)
- Angelo Restivo
- Department of Surgical Sciences, University of Cagliari, Cagliari, Italy. .,Chirurgia Generale M - Colorectal Center, AOU Cagliari, Cagliari, Italy.
| | - Luigi Zorcolo
- Department of Surgical Sciences, University of Cagliari, Cagliari, Italy.,Chirurgia Generale M - Colorectal Center, AOU Cagliari, Cagliari, Italy
| | - Giuseppe D'Alia
- Chirurgia Generale M - Colorectal Center, Digestive Surgical Endoscopy section, AOU Cagliari, Cagliari, Italy
| | - Francesca Cocco
- Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
| | - Andrea Cossu
- Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
| | - Francesco Scintu
- Department of Surgical Sciences, University of Cagliari, Cagliari, Italy.,Chirurgia Generale M - Colorectal Center, AOU Cagliari, Cagliari, Italy
| | - Giuseppe Casula
- Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
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Shafik AA, El Sibai O, Shafik IA. Rectocele repair with stapled transvaginal rectal resection. Tech Coloproctol 2015; 20:207-14. [PMID: 26711102 DOI: 10.1007/s10151-015-1410-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Accepted: 06/02/2015] [Indexed: 12/14/2022]
Abstract
BACKGROUND Constipation is a clinical symptom in patients suffering from slow transit and/or obstructed defecation. Proper treatment requires the identification of all associated disorders and the quantification of symptoms. Rectocele can cause the symptoms of obstructed defecation syndrome (ODS). The aim of this study was to evaluate the clinical and functional outcomes of a novel technique of transvaginal stapled rectal resection (TVSRR) using a straight staple line, to treat rectocele. METHODS The study included 84 females [median age 51 years (range 29-73 years)], with obstructed defecation, grades II-III rectocele, and multiple abnormalities on defecography. The magnitude and degree of ODS were quantified by the Altomare ODS scoring system. Continence status was evaluated using the Pescatori scoring system. The rectal and vaginal manometric study, the index of patient satisfaction using a visual analog score (VAS), and the validated Patient Assessment of Constipation Quality of Life (PAC-QOL) questionnaire results were recorded. All patients underwent TVSRR. RESULTS There were no intraoperative complications. Early postoperative complications were defecatory urgency in seven patients (8.3 %), dyspareunia in two (2.4 %), and rectovaginal fistula in one (1.2 %). Five patients (6 %) had recurrence of ODS symptoms. There was no significant change in continence pre- and postoperatively. The ODS score and VAS revealed significant improvement within the first postoperative year in 94 % of patients. The PAC-QOL questionnaire mean total scores indicated an improvement in both the patient satisfaction and the QOL during the 12-month follow-up. The self-reported definitive outcome was excellent in 46 patients (54.7 %), good in 29 (34.5 %), fairly good in 20 (23.8 %), and poor in five (6.0 %). CONCLUSIONS Vaginal repair carries no risk of fecal incontinence. Large anterior rectocele is considered the main indication for this technique. Using the linear stapler is a cost-effective, simple, and easy technique.
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Affiliation(s)
- A A Shafik
- Department of Surgery, Faculty of Medicine, Cairo University, 7, Gamal Salem St., Off Mossadak St., Dokki, Cairo, Egypt.
| | - O El Sibai
- Department of Surgery, Faculty of Medicine, Menoufia University, Al Minufiya, Egypt
| | - I A Shafik
- Department of Surgery, Faculty of Medicine, Cairo University, 7, Gamal Salem St., Off Mossadak St., Dokki, Cairo, Egypt
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Asciore L, Pescatori LC, Pescatori M. Semi-closed bilateral partial miotomy of the puborectalis for anismus: a pilot study: Partial miotomy of the puborectalis for anismus. Int J Colorectal Dis 2015; 30:1729-34. [PMID: 26255256 DOI: 10.1007/s00384-015-2330-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/26/2015] [Indexed: 02/04/2023]
Abstract
BACKGROUND Anismus or non relaxing puborectalis muscle (PRM) may cause obstructed defecation (OD). Reported surgical treatment is partial miotomy, followed by sepsis, bleeding, and incontinence. The aim of the present study was to investigate on the feasibility and outcome of a modified mini-invasive operation. PATIENTS AND METHODS Consecutive patients with anismus and OD not responding to medical therapy, excluding multiparous females, patients with anal incontinence, recto-rectal intussusception, and disordered psychological pattern. Semi-closed bilateral partial division of PRM, pulled down through 1-cm perianal incisions, was performed. Concomitant significant rectal mucosal prolapse and rectocele, when present, were treated. OD was evaluated using a validated score and anal/vaginal ultrasound (US) was performed pre -and postoperatively. A control group of seven patients with normal bowel habit was also investigated. RESULTS Eight patients (seven females), median age 48 years (range 29-71) were operated. Six also had significant mucosal prolapse and rectocele. All were followed up for a median of 12 months (range 2-40). None of them had postoperative sepsis or bleeding. One had just one occasional episode of mild anal incontinence. Symptoms improved in 6 or 75 % and, OD score decreased from 19.6 ± 1.0 to 9.2 ± 2.0 (mean ± s.e.m.), P = 0.007. No patient had anismus after surgery and PRM relaxation changed from 0 to 5.9 ± 0.8 mm being 6.6 ± 1.5 mm in controls. CONCLUSION Semi-closed bilateral partial division of PRM achieves muscle's relaxation on straining in all patients without any significant postoperative complication. Further studies are needed prior to consider it a validated procedure.
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Affiliation(s)
- L Asciore
- Coloproctology Unit, Parioli Clinic, Rome, Italy
| | | | - M Pescatori
- Coloproctology Unit, Parioli Clinic, Rome, Italy.
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Randomized clinical trial of transcutaneous electrical posterior tibial nerve stimulation versus lateral internal sphincterotomy for treatment of chronic anal fissure. Int J Surg 2015; 22:143-8. [PMID: 26316154 DOI: 10.1016/j.ijsu.2015.08.033] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2015] [Revised: 08/07/2015] [Accepted: 08/21/2015] [Indexed: 11/22/2022]
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Portilla FDL, Calero-Lillo A, Jiménez-Rodríguez RM, Reyes ML, Segovia-González M, Maestre MV, García-Cabrera AM. Validation of a new scoring system: Rapid assessment faecal incontinence score. World J Gastrointest Surg 2015; 7:203-207. [PMID: 26425269 PMCID: PMC4582238 DOI: 10.4240/wjgs.v7.i9.203] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Revised: 06/06/2015] [Accepted: 07/17/2015] [Indexed: 02/06/2023] Open
Abstract
AIM: To implement a quick and simple test - rapid assessment faecal incontinence score (RAFIS) and show its reliability and validity.
METHODS: From March 2008 through March 2010, we evaluated a total of 261 consecutive patients, including 53 patients with faecal incontinence. Demographic and comorbidity information was collected. In a single visit, patients were administered the RAFIS. The results obtained with the new score were compared with those of both Wexner score and faecal incontinence quality of life scale (FIQL) questionnaire. The patient without influence of the surgeon completed the test. The role of surgeon was explaining the meaning of each section and how he had to fill. Reliability of the RAFIS score was measured using intra-observer agreement and Cronbach’s alpha (internal consistency) coefficient. Multivariate analysis of the main components within the different scores was performed in order to determine whether all the scores measured the same factor and to conclude whether the information could be encompassed in a single factor. A sample size of 50 patients with faecal incontinence was estimated to be enough to detect a correlation of 0.55 or better at 5% level of significance with 80% power.
RESULTS: We analysed the results obtained by 53 consecutive patients with faecal incontinence (median age 61.55 ± 12.49 years) in the three scoring systems. A total of 208 healthy volunteers (median age 58.41 ± 18.41 years) without faecal incontinence were included in the study as negative controls. Pearson’s correlation coefficient between “state” and “leaks” was excellent (r = 0.92, P < 0.005). Internal consistency in the comparison of “state” and “leaks” yielded also excellent correlation (Cronbach’s α = 0.93). Results in each score were compared using regression analysis and a correlation value of r = 0.98 was obtained with Wexner score. As regards FIQL questionnaire, the values of “r” for the different subscales of the questionnaire were: “lifestyle”r = -0.87, “coping/behaviour”r = -0.91, “depression”r = -0.36 and “embarrassment”r = -0.90, (P < 0.01). A multivariate analysis showed that all the scoring systems measured the same factor. A single factor may explain 80.84% of the variability of FI, so all the scoring systems measure the same factor. Patient’s continence improves when RAFIS and Jorge-Wexner scores show low values and when the values obtained in the FIQL questionnaire are high.
CONCLUSION: RAFIS is a valid and reliable tool to assess Faecal Incontinence.
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Pucciani F, Altomare DF, Dodi G, Falletto E, Frasson A, Giani I, Martellucci J, Naldini G, Piloni V, Sciaudone G, Bove A, Bocchini R, Bellini M, Alduini P, Battaglia E, Galeazzi F, Rossitti P, Usai Satta P. Diagnosis and treatment of faecal incontinence: Consensus statement of the Italian Society of Colorectal Surgery and the Italian Association of Hospital Gastroenterologists. Dig Liver Dis 2015; 47:628-45. [PMID: 25937624 DOI: 10.1016/j.dld.2015.03.028] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Revised: 03/08/2015] [Accepted: 03/28/2015] [Indexed: 02/06/2023]
Abstract
Faecal incontinence is a common and disturbing condition, which leads to impaired quality of life and huge social and economic costs. Although recent studies have identified novel diagnostic modalities and therapeutic options, the best diagnostic and therapeutic approach is not yet completely known and shared among experts in this field. The Italian Society of Colorectal Surgery and the Italian Association of Hospital Gastroenterologists selected a pool of experts to constitute a joint committee on the basis of their experience in treating pelvic floor disorders. The aim was to develop a position paper on the diagnostic and therapeutic aspects of faecal incontinence, to provide practical recommendations for a cost-effective diagnostic work-up and a tailored treatment strategy. The recommendations were defined and graded on the basis of levels of evidence in accordance with the criteria of the Oxford Centre for Evidence-Based Medicine, and were based on currently published scientific evidence. Each statement was drafted through constant communication and evaluation conducted both online and during face-to-face working meetings. A brief recommendation at the end of each paragraph allows clinicians to find concise responses to each diagnostic and therapeutic issue.
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Affiliation(s)
| | - Filippo Pucciani
- Department of Surgery and Translational Medicine, University of Florence, Italy.
| | | | - Giuseppe Dodi
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Italy
| | - Ezio Falletto
- I Division of Surgical Sciences, Città della Salute e della Scienza Hospital, University of Turin, Italy
| | - Alvise Frasson
- Department of Surgery, Oncology and Gastroenterology, University of Padua, Italy
| | - Iacopo Giani
- Proctological and Perineal Surgical Unit, University Hospital of Pisa, Italy
| | - Jacopo Martellucci
- General, Emergency and Minimally Invasive Surgery, Careggi University Hospital, Florence, Italy
| | - Gabriele Naldini
- Proctological and Perineal Surgical Unit, University Hospital of Pisa, Italy
| | | | - Guido Sciaudone
- General and Geriatric Surgery Unit, School of Medicine, Second University of Naples, Italy
| | | | - Antonio Bove
- Gastroenterology and Endoscopy Unit, Department of Gastroenterology - AORN "A. Cardarelli", Naples, Italy
| | - Renato Bocchini
- Gastrointestinal Physiopathology, Gastroenterology Department, Malatesta Novello Private Hospital, Cesena, Italy
| | - Massimo Bellini
- Gastrointestinal Unit, Department of Gastroenterology, University of Pisa, Italy
| | - Pietro Alduini
- Digestive Endoscopy Unit, San Luca Hospital, Lucca, Italy
| | - Edda Battaglia
- Gastroenterology and Endoscopy Unit, Cardinal Massaia Hospital, Asti, Italy
| | | | - Piera Rossitti
- Gastroenterology Unit, S.M. della Misericordia University Hospital, Udine, Italy
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Villot A, Deffieux X, Demoulin G, Rivain AL, Trichot C, Thubert T. [Management of postpartum anal incontinence: A systematic review]. Prog Urol 2015; 25:1191-203. [PMID: 26162323 DOI: 10.1016/j.purol.2015.06.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Revised: 06/01/2015] [Accepted: 06/07/2015] [Indexed: 12/14/2022]
Abstract
AIM To analyse the prevalence of postpartum anal incontinence, its risk factors, and its management. MATERIALS AND METHODS A comprehensive systematic review of the literature on PubMed, Medline, Embase and Cochrane using: postpartum anal incontinence, postpartum fecal incontinence, perineal rehabilitation, anal surgery. RESULTS The prevalence of postpartum anal incontinence varied from 4% (primipare) to 39% (multipare) at 6 weeks postpartum, whereas fecal incontinence can reach respectively 8 to 12% 6 years after delivery. Identified risk factors were: vaginal delivery (OR: 1.32 [95%CI: 1.04-1.68]) compared to cesarean section, instrumental extractions (OR: 1.47 [95%CI: 1.22-1.78]) compared to spontaneous vaginal delivery but it was only with forceps (OR: 1.50 [95%CI: 1.19-1.89]) and not with vaccum (OR: 1.31 [95%CI: 0.97-1.77]). Maternal age over 35 years (OR: 6 [95%CI: 1.85-19.45]), number of births (3 births: OR: 2.91 [95%CI: 1.32-6.41]) and the occurrence of anal-sphincter injury (OR: 2.3 [95%CI: 1.1-5]) were associated with an increased risk of anal incontinence regardless of the type of delivery compared to a group of women without anal incontinence. Perineal rehabilitation should be interpreted with caution because of the lack of randomized controlled trials. A reassessment at 6 months postpartum in order to propose a surgical treatment by sphincteroplasty could be considered if symptoms persist. The results of the sphincteroplasty were satisfactory but with a success rate fading in time (60 to 90% at 6 months against 50 to 40% at 5 and 10 years). CONCLUSION Postpartum anal incontinence requires special care. Recommendations for the management of postpartum anal incontinence would be useful.
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Affiliation(s)
- A Villot
- Service de gynécologie-obstétrique et biologie de la reproduction, hôpital Antoine-Béclère, AP-HP, 157, rue de la Porte-de-Trivaux, 92140 Clamart, France; GMC-UPMC 01, GREEN, Group of Clinical Research in Neuro-Urology, University Pierre-and-Marie-Curie, 4, rue de la Chine, 75020 Paris, France
| | - X Deffieux
- Service de gynécologie-obstétrique et biologie de la reproduction, hôpital Antoine-Béclère, AP-HP, 157, rue de la Porte-de-Trivaux, 92140 Clamart, France; GMC-UPMC 01, GREEN, Group of Clinical Research in Neuro-Urology, University Pierre-and-Marie-Curie, 4, rue de la Chine, 75020 Paris, France
| | - G Demoulin
- Service de gynécologie-obstétrique et biologie de la reproduction, hôpital Antoine-Béclère, AP-HP, 157, rue de la Porte-de-Trivaux, 92140 Clamart, France
| | - A-L Rivain
- Service de gynécologie-obstétrique et biologie de la reproduction, hôpital Antoine-Béclère, AP-HP, 157, rue de la Porte-de-Trivaux, 92140 Clamart, France
| | - C Trichot
- Service de gynécologie-obstétrique et biologie de la reproduction, hôpital Antoine-Béclère, AP-HP, 157, rue de la Porte-de-Trivaux, 92140 Clamart, France
| | - T Thubert
- Service de gynécologie-obstétrique et biologie de la reproduction, hôpital Antoine-Béclère, AP-HP, 157, rue de la Porte-de-Trivaux, 92140 Clamart, France; GMC-UPMC 01, GREEN, Group of Clinical Research in Neuro-Urology, University Pierre-and-Marie-Curie, 4, rue de la Chine, 75020 Paris, France.
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Uribe N, Balciscueta Z, Mínguez M, Martín MC, López M, Mora F, Primo V. "Core out" or "curettage" in rectal advancement flap for cryptoglandular anal fistula. Int J Colorectal Dis 2015; 30:613-9. [PMID: 25612521 DOI: 10.1007/s00384-015-2133-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/10/2015] [Indexed: 02/04/2023]
Abstract
AIM Transanal advancement flap is a recognized technique for complex fistula. Management of the tract is open to discussion. Excision of the tract by the "core out" technique is difficult and could increase the risk of sphincter damage. Curettage is easier but it could increase the risk of recurrence. The aim of the present study was to assess the effect of both techniques on sphincter function and to study the clinical results. METHOD This is a retrospective analysis from a prospective database. One hundred nineteen consecutive patients with high cryptoglandular anal fistula were included. "Core out" technique was performed in 78 patients (group I) and "curettage" in 41 (group II). In both, a full-thickness rectal flap was advanced over the closed internal defect. Anorectal manometry was performed to assess sphincter function. Continence was assessed using the Wexner Scale. Recurrence was defined as the presence of an abscess or fistulization. RESULTS Manometric results showed a significant decrease in the maximum resting pressure after surgery in both groups. The maximum squeeze pressure was significantly reduced only in group I (p < 0.001). No significant changes in Wexner score were observed. The overall recurrence rate was 5.88%, five of group I (6.4%) and two of group II (4.9%), without statistical significance (p = 0.74). CONCLUSIONS The core-out technique causes a significant decrease in squeeze pressures, which reflects damage to the external anal sphincter. This could lead to incontinence in high-risk patients. Curettage is a simple technique that preserves the values of squeeze pressures without increasing recurrence rates.
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Affiliation(s)
- Natalia Uribe
- Unit of Coloproctology, Department of Surgery, Hospital Arnau de Vilanova of Valencia, Valencia, Spain,
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Anterior sphincteroplasty for fecal incontinence: predicting incontinence relapse. Int J Colorectal Dis 2015; 30:513-20. [PMID: 25694138 DOI: 10.1007/s00384-015-2162-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/09/2015] [Indexed: 02/04/2023]
Abstract
PURPOSE This study was designed to evaluate the efficiency of anterior sphincteroplasty in preventing fecal incontinence relapsing in 85 female patients. METHODS This observational study followed individuals for up to 10 years after intervention. Fecal incontinence relapse was analyzed using Generalized Linear Models and Kaplan-Meier tables. Bias due to informative censoring and missing data were assessed. Two postoperative cutoff Wexner scores (4 and 8) were used to classify individuals into continent or incontinent, and their model implications were examined. RESULTS The hazard of relapsing appeared constant over time. This led to exponential time-to-relapse functions, and a linear increase of cumulative hazard over time. Predicted median relapsing time was 33 years, and overall risk 0.09 ± 0.03, when using a cutoff Wexner score of 8 (moderate), and 5 years, overall risk 0.45 ± 0.05, when using a cutoff of 4 (mild). There was a potential underestimation in parameters (bias) due to informative censoring, i.e., individual with better prognoses were more likely to drop out before relapsing compared to those with worse prognoses. Thus, true relapsing times may be longer than our current estimates. CONCLUSIONS The predictive model can be used in practice for individual prognosis after intervention, based on preoperative Wexner scores. The effect of anterior sphincteroplasty on fecal incontinence does not seem to deteriorate over time. A consensus Wexner cutoff is necessary to compare data and interventions.
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Theodoropoulos GE, Spiropoulos V, Bramis K, Plastiras A, Zografos G. Dermal Flap Advancement Combined with Conservative Sphincterotomy in the Treatment of Chronic Anal Fissure. Am Surg 2015. [DOI: 10.1177/000313481508100224] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Lateral internal sphincterotomy (LIS) is considered the surgical treatment of choice for chronic anal fissure (CAF). Flap techniques for fissure coverage have the advantage of primary wound healing, potentially providing better functional results and faster pain relief. The standard surgical strategy for CAF consisting of conventional LIS (CLIS) up tothe dentate line was modified by “tailoring” the LIS to the apex of the CAF, but never greater than 1 cm, and by advancing a dermal flap for coverage of the CAF (LIS + flap) after fissurectomy. Thirty consecutive patients who underwent “LIS + flap” were compared with 32 patients who had been previously treated by CLIS. A modified, trapezoidlike Y-V flap from perianal skin was advanced into the CAF base. Pain at the first postoperative day, pain at defecation during the first week, postoperative use of analgesics, and time for patients’ pain relief were significantly less at the “LIS + flap” group ( P < 0.01). Objective healing was achieved faster ( P < 0.01) and soiling episodes were less ( P < 0.05) after “LIS + flap.” The addition of a dermal flap after “conservative” LIS resulted in better healing and significantly less postoperative discomfort than the isolated application of CLIS.
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Affiliation(s)
- George E. Theodoropoulos
- Colorectal and Inflammatory Bowel Diseases Unit, First Department of Propaedeutic Surgery of Athens Medical School, Athens, Greece
| | - Vasileios Spiropoulos
- Colorectal and Inflammatory Bowel Diseases Unit, First Department of Propaedeutic Surgery of Athens Medical School, Athens, Greece
| | - Konstantinos Bramis
- Colorectal and Inflammatory Bowel Diseases Unit, First Department of Propaedeutic Surgery of Athens Medical School, Athens, Greece
| | - Aris Plastiras
- Colorectal and Inflammatory Bowel Diseases Unit, First Department of Propaedeutic Surgery of Athens Medical School, Athens, Greece
| | - George Zografos
- Colorectal and Inflammatory Bowel Diseases Unit, First Department of Propaedeutic Surgery of Athens Medical School, Athens, Greece
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