scholarly journals Dynamic versus Adynamic Graciloplasty in Treatment of End-Stage Fecal Incontinence: Is the Implantation of the Pacemaker Really Necessary? 12-Month Follow-Up in a Clinical, Physiological, and Functional Study

2015 ◽  
Vol 2015 ◽  
pp. 1-5 ◽  
Author(s):  
Piotr Walega ◽  
Michal Romaniszyn ◽  
Benita Siarkiewicz ◽  
Dorota Zelazny
Keyword(s):  
Quality Of Life ◽  
Fecal Incontinence ◽  
Functional Results ◽  
Severity Index ◽  
Functional Study ◽  
Dynamic Graciloplasty ◽  
Related Complication ◽  
Complication Risk ◽  
End Stage

Purpose. The aim of the study is to compare functional results of end-stage fecal incontinence treatment with dynamic graciloplasty and adynamic graciloplasty augmented with transanal conditioning of the transposed muscle.Methods. A total of 20 patients were qualified for graciloplasty procedure due to end-stage fecal incontinence. 7 patients underwent dynamic graciloplasty (DGP), whereas 13 patients were treated with adynamic graciloplasty, with transanal stimulation in the postoperative period (AGP). Clinical, functional, and quality of life assessments were performed 3, 6, and 12 months after the procedures.Results. There were no intraoperative or early postoperative complications. The detachment of gracilis muscle tendon was observed in one patient in DGP group and two in AGP group. There was a significant improvement of Fecal Incontinence Quality of Life (FIQL) and Fecal Incontinence Severity Index (FISI) scores in both groups 12 months after procedure. Anorectal manometry showed improvement regarding basal and squeeze pressures in both groups, with significantly better squeeze pressures in AGP group.Conclusions. The functional effects in the DGP and AGP groups were similar. Significantly lower price of the procedure and avoidance of implant-related complication risk suggest the attractiveness of the AGP method augmented by transanal stimulation.

Long-Term Outcome after Dynamic Graciloplasty for Treatment of Persistent Fecal Incontinence in Patients with Anorectal Malformations

2018 ◽  
Vol 29 (03) ◽  
pp. 276-281
Author(s):  
Johan Danielson ◽  
Urban Karlbom ◽  
Tomas Wester ◽  
Wilhelm Graf
Keyword(s):  
Quality Of Life ◽  
Fecal Incontinence ◽  
Short Form ◽  
Anorectal Malformations ◽  
Dynamic Graciloplasty ◽  
Term Outcome ◽  
Long Term Outcome

Purpose Dynamic graciloplasty (DGP) has been used to treat severe fecal incontinence since the 1980s. Previous studies have shown an inferior outcome in patients with anorectal malformations (ARMs). Our experience has been that DGP has been appreciated by ARM -patients. The objective of the study was to evaluate the long-term outcome of DGP in our patients with ARM compared with patients with other underlying conditions. Materials and Methods Twenty-three patients operated with DGP at our institution from 1996 to 2010 were sent validated bowel function and quality of life questionnaires. Eighteen of 23 responded. Seven had ARM and 11 had other etiologies of fecal incontinence. The mean follow-up time was 11.6 years (range, 5–17). Results Four of 7 of the patients with ARM and 8 of 11 of patients with other etiologies used their implants at follow-up. The Miller incontinence score was slightly higher for patients with ARMs, but they had less constipation and higher Fecal Incontinence Quality of Life (FIQL)- and 36-Item Short Form Health Survey (SF-36) scores. None of the differences were statistically significant. Conclusion This study cannot confirm earlier reports in which DGP has an inferior outcome in patients with ARM. We therefore believe that the procedure should remain a treatment option for selected patients.

PS01.010: CLINICAL AND FUNCTIONAL RESULTS OF PULL-DOWN HELLER-DOR AND ESOPHAGECTOMY FOR END-STAGE ACHALASIA: A PROSPECTIVE STUDY

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 52-52
Author(s):  
Valentina Tassi ◽  
Marialuisa Lugaresi ◽  
Benedetta Mattioli ◽  
Niccolò Daddi ◽  
Sandro Mattioli
Keyword(s):  
Quality Of Life ◽  
Conflicts Of Interest ◽  
Bodily Pain ◽  
Functional Results ◽  
Objective Evaluation ◽  
Reflux Symptoms ◽  
Sf 36 ◽  
End Stage ◽  
A Prospective Study

Abstract Background The Heller-Dor associated with the verticalization of distal esophagus (pull-down technique PD-HD) or esophagectomy (E) may be indicated for therapy of dysphagia in end-stage achalasia the latter also prevents development of carcinoma. We compared results achieved after PD-HD and E. Methods Twenty-nine patients (median age 57 years IQR 49–69 years) were submitted to PD-HD and 20 patients (median age 64 years IQR 56–69 years) (P = 0.321) were submitted to E for end stage achalasia or for cancer (patients recurrence free). We adopted semi quantitative scales to investigate dysphagia, reflux symptoms and esophagitis. With SF-36 quality of life was assessed. Results Median follow-up was 134.13 months (IQR 92.36 - 167.03 months) for PD-HD and 42.77 months (IQR 23.57 - 65.17 months) for E (P = 0.001). No statistically significant differences were observed with regards to the objective evaluation of dysphagia, reflux symptoms and esophagitis (P = 0.515). No statistically significant differences were calculated between the two groups as it concerns the domains general health (P = 0.302), physical functioning (P = 0.275), role physical (P = 0.107) and bodily pain (P = 0.057). Significant differences with regards to the domains role emotional (PD-HD 100, E 75, P = 0.012), vitality (PD-HD 90, E 60, P < 0.001), mental health (PD-HD 92, E 69, P = 0.001) and social functioning (PD-HD 100, E 75, P = 0.014) were observed in favour of PD-HD (Figure). Conclusion With respect to E, PD-HD achieved similar dysphagia, GER control, better quality of life. PD-HD is the procedure of choice for patients with low or null risk for cancer. Disclosure All authors have declared no conflicts of interest.

Functional Outcomes and Quality of Life after Anorectal Surgery

2012 ◽  
Vol 78 (9) ◽  
pp. 952-956 ◽  
Author(s):  
Alexis Grucela ◽  
Brooke Gurland ◽  
Ravi P. Kiran
Keyword(s):  
Quality Of Life ◽  
Functional Outcomes ◽  
Pilonidal Disease ◽  
Functional Results ◽  
Severity Index ◽  
Anorectal Surgery ◽  
Postoperative Function ◽  
Fecal Incontinence Severity Index ◽  
Electronic Questionnaires

There is a paucity of information examining quality of life (QOL) and functional results after anorectal surgery. We aim to prospectively evaluate postoperative QOL, pain, functional outcomes, and satisfaction for a large cohort of patients undergoing anorectal surgery. Data were prospectively accrued for consecutive patients undergoing anorectal operations from June 2009 to September 2010. Preoperative and postoperative electronic questionnaires were completed. QOL was evaluated by the European QOL index (EQ-5D) and functional results with the Fecal Incontinence Severity Index (FISI). Satisfaction was assessed: 1) Are you satisfied with surgery? 2) Would you recommend surgery to others? Responses were reported: 1 to 5 (1 = not at all; 5 = a lot). Pain was scored: 1 (no pain) to 10 (worst). One hundred ninety-five patients, 111 (56.9%) females, median age 44 years (range, 18 to 93 years), underwent anorectal surgery for abscess, condyloma, fissure, fistula, hemorrhoids, incontinence, pilonidal disease, pouch problems, tumors, and prolapse. Overall, pain improved significantly with improved QOL ( P = 0.03). This correlated with overall postoperative satisfaction (92.4%). A total of 87.7 per cent of patients would recommend their surgery to others. The FISI was similar pre- and postoperatively ( P = 0.18) and did not worsen postoperatively irrespective of surgical indication and procedure. Most patients were satisfied after anorectal surgery, which correlated with improved pain and QOL. Functional outcomes did not worsen. This will help counsel patients preoperatively and allay anxiety about postoperative function.

The fecal incontinence quality of life scale (FIQL) and fecal incontinence severity index (FISI): Validation of the Dutch versions

2016 ◽  
Vol 36 (3) ◽  
pp. 710-715 ◽  
Author(s):  
Lisette A. ‘t Hoen ◽  
Elaine Utomo ◽  
Willem R. Schouten ◽  
Bertil F.M. Blok ◽  
Ida J. Korfage
Keyword(s):  
Quality Of Life ◽  
Fecal Incontinence ◽  
Severity Index ◽  
Quality Of Life Scale ◽  
Life Scale ◽  
Fecal Incontinence Severity Index

scholarly journals EARLY FUNCTIONAL RESULTS OF BIOFEEDBACK AND ITS IMPACT ON QUALITY OF LIFE OF PATIENTS WITH ANAL INCONTINENCE

2013 ◽  
Vol 50 (3) ◽  
pp. 163-169 ◽  
Author(s):  
Fernando Rocha LEITE ◽  
Marcilio Jose Rodrigues de LIMA ◽  
Antonio LACERDA-FILHO
Keyword(s):  
Quality Of Life ◽  
Fecal Incontinence ◽  
Functional Results ◽  
Sphincter Muscle ◽  
Clinical Variables ◽  
Functional Parameters ◽  
Validated Questionnaires ◽  
Severity Scores ◽  
Quality Of Life Scale

Context Biofeedback has been used successfully in the treatment of fecal incontinence, working mainly on rehabilitation of the sphincter muscle. However, there are few studies presenting objective results of biofeedback, in terms of functional results and those related to the quality of life. Objectives The aims of this study was to evaluate the immediate results of biofeedback in the treatment of fecal incontinence and its impact on the quality of life of patients by using validated questionnaires, correlating the results with those related to functional parameters of quality of life and clinical variables. Methods We analyzed and compared the results of biofeedback in 52 patients with fecal incontinence before the start of the sessions and immediately after the end of them, by applying validated questionnaires assessing the degree of intensity of fecal incontinence (FISI - Fecal Incontinence Severity Index) and evaluation of quality of life related to fecal incontinence (FIQL - Faecal Incontinence Quality of Life Scale) as compared to clinical variables (age, onset of symptoms, etiology of the fecal incontinence, number of sessions of biofeedback and number and types of deliveries). Results The evaluation of the results of FISI showed a significant increase in the number of individuals who had low severity scores of symptoms before and after the biofeedback (from 48.1 to 65.4%) with P = 0.004. There was significant improvements in domains of the FIQL, behavior (P = 0.008), depression (P = 0.006) and embarrassment (P = 0.008) after biofeedback. There was no significant correlation between the improvement of functional parameters evaluated by FISI and the improvement of quality of life. Positive correlation was found between the improvements of the domains of FIQL. There was no significant correlation between the results obtained using the FISI and FIQL with clinical variables assessed. Conclusions Biofeedback has proven to be an effective therapy in the treatment of fecal incontinence, improving symptoms and/or quality of life for most patients, regardless of clinical presentation of this functional disorder.

scholarly journals Emergency Medicine Palliative Care Access (EMPallA): protocol for a multicentre randomised controlled trial comparing the effectiveness of specialty outpatient versus nurse-led telephonic palliative care of older adults with advanced illness

BMJ Open ◽  
2019 ◽  
Vol 9 (1) ◽  
pp. e025692 ◽  
Author(s):  
Corita R Grudzen ◽  
Deborah J Shim ◽  
Abigail M Schmucker ◽  
Jeanne Cho ◽  
Keith S Goldfeld
Keyword(s):  
Quality Of Life ◽  
Older Adults ◽  
Palliative Care ◽  
Randomised Controlled Trial ◽  
Case Management ◽  
Controlled Trial ◽  
Chronic Obstructive ◽  
Randomised Controlled ◽  
End Stage

IntroductionEmergency department (ED)-initiated palliative care has been shown to improve patient-centred outcomes in older adults with serious, life-limiting illnesses. However, the optimal modality for providing such interventions is unknown. This study aims to compare nurse-led telephonic case management to specialty outpatient palliative care for older adults with serious, life-limiting illness on: (1) quality of life in patients; (2) healthcare utilisation; (3) loneliness and symptom burden and (4) caregiver strain, caregiver quality of life and bereavement.Methods and analysisThis is a protocol for a pragmatic, multicentre, parallel, two-arm randomised controlled trial in ED patients comparing two established models of palliative care: nurse-led telephonic case management and specialty, outpatient palliative care. We will enrol 1350 patients aged 50+ years and 675 of their caregivers across nine EDs. Eligible patients: (1) have advanced cancer (metastatic solid tumour) or end-stage organ failure (New York Heart Association class III or IV heart failure, end-stage renal disease with glomerular filtration rate <15 mL/min/m2, or global initiative for chronic obstructive lung disease stage III, IV or oxygen-dependent chronic obstructive pulmonary disease); (2) speak English; (3) are scheduled for ED discharge or observation status; (4) reside locally; (5) have a working telephone and (6) are insured. Patients will be excluded if they: (1) have dementia; (2) have received hospice care or two or more palliative care visits in the last 6 months or (3) reside in a long-term care facility. We will use patient-level block randomisation, stratified by ED site and disease. Effectiveness will be compared by measuring the impact of each intervention on the specified outcomes. The primary outcome will measure change in patient quality of life.Ethics and disseminationInstitutional Review Board approval was obtained at all study sites. Trial results will be submitted for publication in a peer-reviewed journal.Trial registration numberNCT03325985; Pre-results.

scholarly journals Outcomes in Hirschsprung’s disease with coexisting learning disability

2021 ◽  
Author(s):  
Joseph R. Davidson ◽  
Kristiina Kyrklund ◽  
Simon Eaton ◽  
Mikko P. Pakarinen ◽  
David Thompson ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Learning Disability ◽  
Hirschsprung's Disease ◽  
Hirschsprung’S Disease ◽  
Core Outcome Set ◽  
Functional Results ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Related Quality

AbstractThis study describes functional and health-related quality of life (HRQoL) outcomes in patients with Hirschsprung’s disease (HSCR) with associated learning disability or neurodevelopmental delay (LD), completing a core outcome set for HSCR. This was a cross-sectional study from a tertiary pediatric surgery center. Patients treated between 1977 and 2013 were prospectively contacted to complete an outcomes survey. Children under 12 and older patients with LD were assisted to complete these by a proxy. Bowel and urologic function were assessed (Rintala’s BFS and modified DanPSS) along with HRQoL (PedsQL/GIQLI/SF-36). Thirty-two patients with LD were compared to 186 patients with normal cognition. Patients with LD had 76% survival over the follow-up period, compared to 99% in the remainder of the cohort. Poor functional outcomes were common in the patients with LD, considerably higher than cognitively normal patients: with weekly issues withholding stool, soiling and fecal accidents in over half of patients surveyed (44–60%), and urinary incontinence in 46%. Use of permanent stoma was significantly higher (22% vs. 4%; p = 0.001). HRQoL was worse in domains of physical functioning in adults and children but not for social or emotional domains in adults. Subgroup analysis of patients with Down syndrome suggested similar functional results but better QoL. Multivariate analysis demonstrated a dramatically higher incidence of poor continence outcomes in patients with LD (adjusted OR 9.6 [4.0–23]).Conclusions: We provide LD-specific outcomes showing inferior function but similar HRQoL to other patients with HSCR, this is much needed in the counselling of families of these children. What is Known:• Hirschsprung’s disease is commonly associated with syndromes or other anomalies with resultant cognitive impairments.• The outcomes for these patients specifically have been poorly described in the literature. What is New:• Objective functional and quality of life surveys demonstrate significant differences from patients without cognitive impairment.• Patients with learning disability Patients with associated LD were almost ten times more likely to have an associated poor functional outcome, with very little impact on proxy-reported quality of life.

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