Techniques and Instruments: Surgical treatment of fecal incontinence

Abstract Background Simple anal fistula is one of the most common causes of proctological surgery and fistulotomy is considered the gold standard. This procedure, however, may cause complications. The aim of this systematic review was to assess the surgical treatment of simple anal fistula with traditional and sphincter-sparing techniques. Methods A literature research was performed using PubMed, Cochrane, and Google Scholar to identify studies on the surgical treatment of simple anal fistulas. Observational studies and randomized clinical trials were included. We assessed the risk of bias of included studies using the Jadad scale for randomized controlled trials, and the MINORS Scale for the remaining studies. Results The search returned 456 records, and 66 studies were found to be eligible. The quality of the studies was generally low. A total of 4883 patients with a simple anal fistula underwent a sphincter-cutting procedure, mainly fistulotomy, with a weighted average healing rate of 93.7%, while any postoperative continence impairment was reported in 12.7% of patients. Sphincter-sparing techniques were adopted to treat 602 patients affected by simple anal fistula, reaching a weighted average success rate of 77.7%, with no study reporting a significant postoperative incontinence rate. The postoperative onset of fecal incontinence and the recurrence of the disease reduced patients’ quality of life and satisfaction. Conclusions Surgical treatment of simple anal fistulas with sphincter-cutting procedures provides excellent cure rates, even if postoperative fecal incontinence is not a negligible risk. A sphincter-sparing procedure could be useful in selected patients.

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Surgical treatment of rectal prolapse: experience and late results with 51 patients

Revista do Hospital das Clínicas ◽

10.1590/s0041-87812004000400003 ◽

2004 ◽

Vol 59 (4) ◽

pp. 168-171 ◽

Cited By ~ 4

Author(s):

Carlos Walter Sobrado ◽

Desidério Roberto Kiss ◽

Sérgio C. Nahas ◽

Sérgio E. A. Araújo ◽

Victor E. Seid ◽

...

Keyword(s):

Surgical Treatment ◽

Fecal Incontinence ◽

Rectal Prolapse ◽

Late Results ◽

Long Term Results ◽

Complete Rectal Prolapse ◽

Presacral Space ◽

Perineal Rectosigmoidectomy ◽

Study Results ◽

Low Incidence

The "best" surgical technique for the management of complete rectal prolapse remains unknown. Due to its low incidence, it is very difficult to achieve a representative number of cases, and there are no large prospective randomized trials to attest to the superiority of one operation over another. PURPOSE: Analyze the results of surgical treatment of complete rectal prolapse during 1980 and 2002. METHOD: Retrospective study. RESULTS: Fifty-one patients underwent surgical treatment during this period. The mean age was 56.7 years, with 39 females. Besides the prolapse itself, 33 patients complained of mucous discharge, 31 of fecal incontinence, 14 of constipation, 17 of rectal bleeding, and 3 of urinary incontinence. Abdominal operations were performed in 36 (71%) cases. Presacral rectopexy was the most common abdominal procedure (29 cases) followed by presacral rectopexy associated with sigmoidectomy (5 cases). The most common perineal procedure was perineal rectosigmoidectomy associated with levatorplasty (12 cases). Intraoperative bleeding from the presacral space developed in 2 cases, and a rectovaginal fistula occurred in another patient after a perineal rectosigmoidectomy. There were 2 recurrences after a mean follow-up of 49 months, which were treated by reoperation. CONCLUSION: Abdominal and perineal procedures can be used to manage complete rectal prolapse with safety and good long-term results. Age, associated medical conditions, and symptoms of fecal incontinence or constipation are the main features that one should bear in mind in order to choose the best surgical approach.

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Fecal incontinence after the surgical treatment of Hirschsprung disease

The Journal of Pediatrics ◽

10.1016/s0022-3476(95)70036-6 ◽

1995 ◽

Vol 127 (6) ◽

pp. 954-957 ◽

Cited By ~ 65

Author(s):

Anthony G. Catto-Smith ◽

Carolyn M.M. Coffey ◽

Terence M. Nolan ◽

John M. Hutson

Keyword(s):

Surgical Treatment ◽

Fecal Incontinence ◽

Hirschsprung Disease

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Surgical Treatment Options For Fecal Incontinence

The Internet Journal of Surgery ◽

10.5580/1c30 ◽

2001 ◽

Vol 1 (2) ◽

Keyword(s):

Surgical Treatment ◽

Fecal Incontinence ◽

Treatment Options

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Surgical Treatment Options For Fecal Incontinence

The Internet Journal of Gastroenterology ◽

10.5580/2952 ◽

2001 ◽

Vol 1 (2) ◽

Keyword(s):

Surgical Treatment ◽

Fecal Incontinence ◽

Treatment Options

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CLINICAL AND MANOMETRIC ASSESMENT OF FUNCTIONAL STATE OF ANAL SPHINCTER IN PATIENTS AFTER FISTULECTOMY WITH PRIMARY SPHINCTEROPLASTY

Koloproktologia ◽

10.33878/2073-7556-2018-0-4-31-38 ◽

2018 ◽

pp. 31-38 ◽

Cited By ~ 1

Author(s):

I. V. Kostarev ◽

O. Yu. Fomenko ◽

A. Yu. Titov ◽

L. A. Blagodarni ◽

S. V. Belousova ◽

...

Keyword(s):

Surgical Treatment ◽

Fecal Incontinence ◽

Anal Sphincter ◽

Anorectal Manometry ◽

Clinical Symptoms ◽

Normal Pressure ◽

Wilcoxon Test ◽

Anal Pressure ◽

Wexner Score ◽

Resting Anal Pressure

AIM: to evaluate changes of anorectal manometry parameters and clinical symptoms of fecal incontinence 3 months after fistulectomy with primary sphincteroplasty. MATERIALS AND METHODS: fifty-two patients (37 males) with complex anal fistulae of cryptoglandular origin underwent fistulectomy and primary sphincteroplasty. The fistulas were recurrent in 13 (25 %) cases, 8 (15,4 %) patients had preoperative fecal incontinence. Fecal incontinence Wexner score was 0,46 (0-8) before surgery. Anorectal manometry was performed before and 3 months after surgery. RESULTS: three months days after surgery mean and maximum resting anal pressure were not significantly low compared with the baseline. In patients with initially normal data before the surgery (n=22), resting anal pressure was significantly lower (before surgery M=56,1 ± 7,6 [46,1-69,0], after surgery 45,5 ± 8,8 [38,0-63,0], p=0,006, Wilcoxon test). There were no significant changes in squeezing anal pressure. Resting anal pressure has become below the normal after surgery in 13 (59.1 %) patients. Clinical symptoms of fecal incontinence was detected in 10 patients postoperatively (gas incontinence and soiling). Fecal incontinence Wexner score was 1,64 (0-11) after surgery (p=0,007). CONCLUSION: fistulectomy with primary sphincteroplasty leads to change of resting anal pressure basically in patients with initially normal pressure and mainly - in patients with anterior fistulas. Fecal incontinence symptoms after with surgery produced 26,3 % patients. These data confirm the need of individual approach when choosing the method of surgical treatment of analfistulae.

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