scholarly journals Multimodal Management of Traumatic Faecal Incontinence Focused on Sphincteroplasty: Long-term Outcomes From a Single Center Case Series

2021 ◽  
Author(s):  
Carlos Cerdán ◽  
Débora Cerdán-Santacruz ◽  
Lucía Milla-Collado ◽  
Antonio Ruiz de León ◽  
Javier Cerdán Miguel
Keyword(s):  
Functional Outcome ◽  
Anal Sphincter ◽  
Nerve Stimulation ◽  
Cleveland Clinic ◽  
Case Series ◽  
Sphincter Repair ◽  
Biofeedback Therapy ◽  
Incontinence Score ◽  
Suboptimal Outcome

Abstract Background: The management of patients with fecal incontinence and an external anal sphincter (EAS) defect remains controversial.Methods: We present a retrospective series of overlapping anal sphincteroplasties performed between 1985-2013 by a single surgeon supplemented by selective puborectalis plication and internal anal sphincter repair. Patients were clinically followed along with anorectal manometry, continence scoring (Cleveland Clinic Incontinence Score - CCS) and patient satisfaction scales. Patients with a suboptimal outcome were managed with combinations of biofeedback therapy, (BFT) peripheral tibial nerve stimulation (PTNS), sacral nerve stimulation (SNS) or repeat sphincteroplasty.Results: There were 120 anterior sphincter repairs with 90 (75%) levatorplasties and 84 (70%) IAS repairs. Over a median follow-up of 120 months (range 60-173.7 months) there were significant improvements in the recorded CCIS values (90.8% with a preoperative CCIS > 15 vs. 2.5% postoperatively; P < 0.001). There were 42 patients who required ancillary treatment with 4 repeat sphincteroplasties, 35 patients undergoing biofeedback therapy, 10 patients treated with PTNS and 3 managed with SNS implants with an ultimate good functional outcome in 92.9% of cases. No difference was noted in ultimate functional outcome between those treated with sphincteroplasty alone compared with those who needed ancillary treatments (97.1% vs. 85.7%, respectively). Overall, 93.3% considered the outcome as either good or excellent.Conclusions: Long-term functional outcomes of an overlapping sphincteroplasty are good. If the initial outcome is suboptimal, response to ancillary treatments remains good and patients are not compromised by a first-up uncomplicated sphincter repair.

Long-Term Results of Anterior Anal Sphincter Repair for Fecal Incontinence due to Obstetric Injury / with Invited Commentaries

2000 ◽  
Vol 17 (4) ◽  
pp. 390-394 ◽  
Author(s):  
J. Rothbarth ◽  
W.A. Bemelman ◽  
W.J.H.J. Meijerink ◽  
M.E. Buyze-Westerweel ◽  
J.G. van Dijk ◽  
...  
Keyword(s):  
Fecal Incontinence ◽  
Anal Sphincter ◽  
Sphincter Repair ◽  
Long Term Results ◽  
Obstetric Injury ◽  
Anal Sphincter Repair

Transcutaneous tibial nerve stimulation for the treatment of faecal incontinence: results of a prospective study

2014 ◽  
Vol 21 (2) ◽  
pp. 91-98 ◽  
Author(s):  
Ieva Stundienė ◽  
Paulius Žeromskas ◽  
Jonas Valantinas
Keyword(s):  
Quality Of Life ◽  
Prospective Study ◽  
Faecal Incontinence ◽  
Nerve Stimulation ◽  
Tibial Nerve ◽  
Cleveland Clinic ◽  
Life Questionnaire ◽  
Incontinence Score ◽  
Tibial Nerve Stimulation

Background. Transcutaneous tibial nerve stimulation is a simple, non-invasive treatment, which can be used to treat faecal incontinence. Optimal treatment regimen is not known and various stimulation regimens are used in different centers. The aim of this prospective study was to evaluate the efficacy of twice weekly transcutaneous tibial nerve stimulation for faecal incontinence patients, who have failed to respond to maximal conservative treatment. Material and methods. Twenty patients with faecal incontinence resistant to maximal conservative therapy were treated with transcutaneous posterior tibial nerve stimulation twice a week for six weeks. The number of the bowel movements per two weeks and the Cleveland Clinic Florida Feacal Incontinence Score were assessed before and after the treatment. The quality of life was estimated using the Faecal Incontinence Quality of Life questionnaire and the Gastrointestinal Quality of Life Index. Results. Effect was seen in 55% of patients. Two-week faecal incontinence episodes decreased from median 4  (2–84) to 2  (0–56) (p = 0.002). The mean Cleveland Clinic Florida Faecal Incontinence score improved from 10.9 ± 4.34 to 7.8 ± 3.96 (p = 0.002). The quality of life improved significantly after the treatment. The therapy was well tolerated and no participant experienced any adverse event. Conclusions. Transcutaneous tibial nerve stimulation twice a week for 6 weeks may be efficacious in patients with faecal incontinence, who have failed to respond to maximal conservative treatments.

Long-term follow-up after anterior sphincter repair: influence of age on functional outcome

2012 ◽  
Vol 14 (11) ◽  
pp. 1380-1388 ◽  
Author(s):  
M. W. Warner ◽  
O. M. Jones ◽  
I. Lindsey ◽  
C. Cunningham ◽  
N. J. Mortensen
Keyword(s):  
Functional Outcome ◽  
Sphincter Repair ◽  
Long Term Follow Up

scholarly journals Effect of Biofeedback Therapy during Temporary Stoma Period in Rectal Cancer Patients: A Prospective Randomized Trial

2021 ◽  
Vol 10 (21) ◽  
pp. 5172
Author(s):  
Hyeon-Min Cho ◽  
Hyungjin Kim ◽  
RiNa Yoo ◽  
Gun Kim ◽  
Bong-Hyeon Kye
Keyword(s):  
Cleveland Clinic ◽  
Controlled Study ◽  
Control Group ◽  
Sensory Threshold ◽  
Biofeedback Therapy ◽  
Incontinence Score ◽  
Temporary Stoma ◽  
Stool Incontinence ◽  
Resting Pressure ◽  
And Control

Background: This prospective randomized controlled study was designed to evaluate the effect of biofeedback therapy (BFT) during temporary stoma period to prevent defecation dysfunction after sphincter-preserving surgery (SPS). Methods: Following SPS with temporary stoma, patients were divided according to whether (BFT group) or not (Control group) they received BFT. BFT was performed once or twice a week during the temporary stoma period. Kegel exercise were advised to all the patients. Subjective defecation symptoms were evaluated according to Cleveland Clinic Incontinence Score (CCIS) as primary outcome at 12 months postoperatively. Manometric data of five time-points were also analyzed. Results: Twenty-one patients in the BFT group and 23 patients in the control group received anorectal physiologic testing. The incidence of CCIS of more than 9 points, which is the primary end point in this study, was not statistically different between BFT group and control group (p = 1.000). The liquid stool incontinence in the BFT group showed a better tendency (p = 0.06) at 12 months post-SPS. Time-dependent serial changes in maximal sensory threshold (Max RST) was significantly different between the BFT and control groups (p = 0.048). Also, the change of mean resting pressure (MRP) tended to be more stable in the BFT group (p = 0.074). Conclusions: The BFT in the period of temporary stoma may be related to liquid stool incontinence at 12 months post-SPS and lead to stable MRP and better Max RST. Therefore, BFT during temporary stoma might be helpful for preventing and minimizing defecation dysfunction in high risk patients after SPS, NCT01661829).

New techniques in the repair of anal sphincter between success and failure

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Ahmed A Darwish ◽  
Ahmed A Khalil ◽  
Mohammed A Hamed ◽  
ElnagehA AbdAlrahem
Keyword(s):  
Anal Sphincter ◽  
Sphincter Repair ◽  
P Value ◽  
University Hospitals ◽  
Endoanal Ultrasonography ◽  
Anal Sphincter Injury ◽  
Long Term Follow Up ◽  
The Mean

Abstract Background Fecal incontinence is a frequent and debilitating condition that may result from a multitude of different causes. It is defined as the uncontrolled passage of faeces or gas over at least 1 month’s duration, in an individual of at least 4 years of age, who had previously achieved control. Aim of Work to evaluate the outcome of overlap anal sphincter repair as regard the anal continence and postoperative complications. Patients and Methods this is a prospective clinical trial was conducted on thirty (30) patients presented to Ain-Shams University hospitals with anal sphincter injury that were operated upon by a modified overlap repair done by the same surgical team. Endoanal ultrasonography was done and Wexner continence score was estimated for all cases preoperatively and postoperatively. All patients sharing in the study were fully informed about the procedure they had with a written informed consent. Results In this study the mean preoperative Wexner score was 12.9 and the mean postoperative Wexner was 4.8; this reduction was found to be significant (p value=0.001). Also endoanal ultrasound showed that tear size significantly reduced among the studied cases(p value=0.001). Conclusion from this study that overlapping sphincter repair is an effective method in the treatment of faecal incontinence in patients with repairable sphincter defects. However, long term follow up is required to confirm its efficacy.

scholarly journals Long Term Clinical and Functional Outcome of Distally Based Sural Artery Flap: A Retrospective Case Series

JPRAS Open ◽  
2021 ◽  
Author(s):  
Pervaiz Mehmood Hashmi ◽  
Abeer Musaddiq ◽  
Muhammad Ali ◽  
Alizah Hashmi ◽  
Marij Zahid ◽  
...  
Keyword(s):  
Functional Outcome ◽  
Case Series ◽  
Retrospective Case ◽  
Retrospective Case Series ◽  
Sural Artery ◽  
Distally Based

scholarly journals Short- and Long-Term Outcomes of Overlap Anal Sphincter Repair for Fecal Incontinence Following Sphincter Injury

2021 ◽  
Vol 41 (01) ◽  
pp. 030-036
Author(s):  
Kasun Lakmal ◽  
Oshan Basnayake ◽  
Umesh Jayarajah ◽  
Dharmabandhu N Samarasekera
Keyword(s):  
Fecal Incontinence ◽  
Anal Sphincter ◽  
Surgical Techniques ◽  
Sphincter Repair ◽  
Significant Heterogeneity ◽  
Long Term Outcomes ◽  
Sphincter Injury ◽  
Short And Long Term ◽  
Poor Outcomes

Abstract Objective Several techniques are used to repair the anal sphincter following injury. The aim of the present study is to comprehensively analyze the short- and long-term outcomes of overlap repair following anal sphincter injury. Methods A search was conducted in the PubMed, Medline, Embase, Scopus and Google Scholar databases between January 2000 and January 2020. Studies that described the outcomes that are specific to overlap sphincter repair for fecal incontinence with a minimum follow-up period of one year were selected. Results A total of 22 studies described the outcomes of overlap sphincter repair. However, 14 studies included other surgical techniques in addition to overlap repair, and were excluded from the analysis. Finally, data from 8 studies including 429 repairs were analyzed. All studies used at least one objective instrument; however, there was significant heterogeneity among them. Most patients were female (n = 407; 94.87%) and the mean age of the included individuals was 44.6 years. The majority of the procedures were performed due to obstetric injuries (n = 384; 89.51%). The eight included studies described long-term outcomes, and seven of them demonstrated statistically significant improvements regarding the continence; one study described poor outcomes in terms of overall continence. The long-term scores were significantly better compared with the preoperative scores. However, compared with the short-term scores, a statistically significant deterioration was noted in the long-term. Conclusion The majority of the studies described good long-term outcomes in terms of anal continence after overlap sphincter repair. However, further studies are needed to identify the factors associated with poor outcomes to assist in patient selection for overlap repair.

scholarly journals Management and Outcome of Hindfoot Trauma With Concomitant Talar Head Injury

2021 ◽  
pp. 107110072098002
Author(s):  
Esmee Wilhelmina Maria Engelmann ◽  
Olivier Wijers ◽  
Jelle Posthuma ◽  
Tim Schepers
Keyword(s):  
Functional Outcome ◽  
Case Series ◽  
Ankle Injuries ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
Long Term Outcome ◽  
Talar Head ◽  
The Mean

Background: Talar head fractures account for 2.6% to 10% of all talar fractures and are often associated with concomitant musculoskeletal injuries. The current literature only describes a total of 14 patients with talar head fractures and, with that, guidelines for management are lacking. The aim of the current study was to evaluate the management and long-term outcome of patients who have hindfoot trauma with concomitant talar head fractures. Methods: This study includes a retrospective cohort of patients with talar head fractures. Patient characteristics, trauma mechanism, fracture characteristics, treatment, follow-up, and complications were reported. Functional outcome was assessed using the Foot Function Index (FFI) and the American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot score. Quality of life was measured by the EuroQol-5D (EQ-5D). Twenty-one patients with acute fractures of the talar head were identified. The mean follow-up time was 4.9 years. Results: All patients sustained additional ipsilateral foot and/or ankle injuries. Fifteen patients had operative management of their talar head fracture. There were no postoperative wound infections and no cases of avascular necrosis. All fractures united, and 29% of patients developed posttraumatic osteoarthritis. The overall mean FFI score index was 34.2, and the mean AOFAS score was 70.7. The mean EQ-5D index score was 0.74. Conclusion: Talar head fractures always coincided with other (foot) fractures. Management and long-term functional outcome were affected by the extent of associated injuries. Due to the low incidence and high complexity of talar head fractures, early referral to dedicated foot surgeons and centralization of complex foot surgery is recommended. Level of Evidence: Level IV, retrospective case series.

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