Garg P, Yagnik VD, Kaur B, Menon GR, Dawka S. Efficacy of Kegel exercises in preventing incontinence after partial division of internal anal sphincter during anal fistula surgery. World J Clin Cases 2022; 10(20): 6845-6854 [PMID: 36051110 DOI: 10.12998/wjcc.v10.i20.6845]
Corresponding Author of This Article
Pankaj Garg, MBBS, MS, Associate Professor, Department of Colorectal Surgery, Garg Fistula Research Institute, 1042/15, Panchkula 134113, Haryana, India. drgargpankaj@gmail.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Cases. Jul 16, 2022; 10(20): 6845-6854 Published online Jul 16, 2022. doi: 10.12998/wjcc.v10.i20.6845
Efficacy of Kegel exercises in preventing incontinence after partial division of internal anal sphincter during anal fistula surgery
Pankaj Garg, Vipul D Yagnik, Baljit Kaur, Geetha R Menon, Sushil Dawka
Pankaj Garg, Department of Colorectal Surgery, Garg Fistula Research Institute, Panchkula 134113, Haryana, India
Pankaj Garg, Department of Colorectal Surgery, Indus International Hospital, Mohali 140507, Punjab, India
Vipul D Yagnik, Department of Surgical Gastroenterology, Nishtha Surgical Hospital and Research Center, Patan 384265, Gujarat, India
Baljit Kaur, Department of Radiology, SSRD Magnetic Resonance Imaging Institute, Chandigarh 160011, India
Geetha R Menon, Department of Statistics, Indian Council of Medical Research, New Delhi 110029, India
Sushil Dawka, Department of Surgery, SSR Medical College, Belle Rive 744101, Mauritius
Author contributions: Garg P conceived and designed the study, collected and analyzed the data, revised the data, finally approved and submitted the manuscript (Guarantor of the study); Yagnik VD and Kaur B collected the data; Yagnik VD, Kaur B and Menon GR analyzed the data, revised the data, finally approved and submitted the manuscript; Dawka S critically analyzed the data, reviewed and edited the manuscript, finally approved and submitted the manuscript.
Institutional review board statement: The study was reviewed and approved by the Indus International Hospital-Institute Ethics Committee (IIH-IEC), No. EC/IIH-IEH/SP6.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author, Dr. Pankaj Garg at drgargpankaj@gmail.com. Participants gave informed consent for data sharing.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Pankaj Garg, MBBS, MS, Associate Professor, Department of Colorectal Surgery, Garg Fistula Research Institute, 1042/15, Panchkula 134113, Haryana, India. drgargpankaj@gmail.com
Received: January 14, 2022 Peer-review started: January 14, 2022 First decision: May 10, 2022 Revised: May 12, 2022 Accepted: June 13, 2022 Article in press: June 13, 2022 Published online: July 16, 2022 Processing time: 171 Days and 22.1 Hours
ARTICLE HIGHLIGHTS
Research background
Certain surgical procedures utilized to treat complex anal fistulas entail partial division of the internal anal sphincter (IAS). The impact of partial division of IAS on continence is not well known.
Research motivation
One of the latest and most effective procedures for complex anal fistulas is the transanal opening of intersphincteric space (TROPIS) procedure which also involves partial incision of the IAS.
Research objectives
The objective was to ascertain the incidence of incontinence after the division of IAS as is done in the TROPIS procedure and to evaluate whether regular Kegel exercises (KE) in the postoperative period can prevent incontinence due to IAS division.
Research methods
Patients with high complex fistulas who were operated on using the TROPIS procedure were recommended KE for 1 year after surgery. The impact of KE was then evaluated in preventing incontinence after surgery.
Research results
Of 102 patients with complex anal fistula who were operated on between July 2018 and July 2020 were included in this study. Overall incontinence occurred in 31% of patients (before doing KE) with urge and gas incontinence accounting for the majority of cases (28.3%). The mean incontinence scores in the patients (before doing KE) were 1.19 ± 1.96. After doing KE regularly, the incontinence remained in only 13% of patients with mean scores decreasing to 0.26 ± 0.77. This improvement in continence was statistically significant (P = 0.00001, t-test).
Research conclusions
The partial division of IAS during anal fistula surgery led to incontinence which was mainly urge incontinence and also to a mild degree of gas and liquid incontinence. However, regular KE led to a significant reduction in incontinence.
Research perspectives
This study would propel further research to evaluate the importance of KE in preventing incontinence after anal surgery.
