Postoperative Anal Incontinence Research Articles

Evaluating the clinical application and effect of acupuncture therapy in anal function rehabilitation after low-tension rectal cancer surgery.

According to the indexes of serum and anal function, acupuncture therapy was applied to patients with low rectal cancer in order to avoid the occurrence of anal incontinence and reduce complications. To explore the clinical application and evaluate the effect of acupuncture therapy for anal function rehabilitation after low-tension rectal cancer surgery. From the anorectal surgery cases, we selected 120 patients who underwent colorectal cancer surgery between January 2020 and December 2022 and randomly divided them into a control group (n = 60), observation group (n = 60), and control group after surgery for lifestyle intervention (including smoking cessation and exercise), dietary factor adjustment, anal movement, and oral loperamide treatment. The serum levels of motilin, 5-hydroxytryptamine, and vasoactive intestinal peptide (VIP), Wexner score for anal incontinence, and incidence of complications were compared between groups. After treatment, the VIP and 5-hydroxytryptamine levels in the observation group were lower than those in the control group (P < 0.05). The motilin level was higher than that in the control group (P < 0.05). Postoperative anal incontinence was better in the observation group than in the control group (P < 0.05). The incidence of complications in the observation group was 6.67%, which was significantly lower than that in the control group (21.67%; P < 0.05). Acupuncture therapy has a positive effect on the rehabilitation of anal function after low-tension rectal cancer surgery; it can effectively help to improve the serum indices of patients, avoid the occurrence of anal incontinence, and reduce the incidence of complications. Popularizing and applying it will be valuable.

Enhanced Approach to Treating Chronic Anal Fissures: Fissurectomy with Vertical Non-full-thickness Midline Sphincterotomy and Mucosal Advancement Flap.

Lateral internal sphincterotomy is a conventional surgical intervention for chronic anal fissures, yet the potential for postoperative anal incontinence underscores the need for an alternative approach. This study aimed to evaluate the outcomes of patients with chronic fissures who underwent a combination of fissurectomy, vertical non-full thickness midline sphincterotomy (VNMS), and mucosal advancement flap (MAF), as a means of mitigating the risk of incontinence. This retrospective analysis included forty-six consecutive patients with chronic anal fissures, unresponsive to topical diltiazem, who underwent fissurectomy combined with VNMS and MAF between April 2018 and May 2023. Primary outcome measures encompassed fissure healing rates. Continence was assessed using the Fecal Incontinence Severity Index (FISI), and manometric assessments were conducted before the procedure and three months postoperatively. With a median follow-up of 27 months, there were no postoperative complications, and the overall fissure healing rate reached 96% (44/46). At three months post-procedure, FISI scores were reduced to 0, with no instances of fecal soiling. Anal resting pressure exhibited a significant reduction at 3 months [pre-op: 133 (95% CI, 128-150) vs. 3 mo: 109 (95% CI, 100-117) cmH2O; p = 0.01]. Similarly, maximum anal squeeze pressure showed a significant decrease three months post-surgery [pre-op: 317 cmH2O (95% CI, 294-380) vs. 3 mo: 291 cmH2O (95% CI, 276-359), p = 0.03]. The combination of fissurectomy, VNMS, and MAF proved to be an effective approach for chronic anal fissures, yielding favorable medium-term outcomes without postoperative anal incontinence.

Treatment with Wound Edges Marsupialization of Simple Anal Fistula: A Randomized Controlled Trial

Introduction: Simple anal fistula can be treated with fistulectomy or fistulotomy. Wound edges marsupialization is a part of treatment. Objectives: To find out the outcomes of the treatment with marsupialization. Methods: Sixty consecutive patients with simple anal fistula were included in this prospective randomized controlled trial study where 30 patients treated with fistulotomy were included group A &amp; 30 patients treated with fistulotomy and marsupialization were included in group B. The primary outcome variable was wound healing time while secondary outcome variables were operating time, postoperative wound size, postoperative pain using visual analogue scale (VAS), post-operative bleeding, wound infection, anal incontinence, recurrence and patient satisfaction. Results: Thirty patients were randomized to group A and 30 to group B. The operating times were significantly different between two groups (21.00±6.35 minutes vs. 28.20±6.57 minutes, P=0.0001) and Postoperative wounds were larger in group A than group B (2.07±0.90 cm2 vs 1.03±0.87 cm2). Bleeding occurred less frequently in group B than group A (10% vs 53.33%, P=0.0003) and wound discharge was observed for a significantly longer duration in group A than group B (4.10±1.8 weeks vs. 2.05±1.71 weeks, P&lt;0.0001). Postoperative wounds in group B healed earlier than group A wounds (3.85±1.19 weeks vs 6.55±1.3 weeks, P&lt;0.0001). VAS scores for postoperative pain on the first postoperative day was (4.05±1.47 vs. 5.15±1.32, P=0.0035) for the two groups. Conclusion: Marsupialization after fistulectomy significantly reduces the healing time, the risk of post-operative bleeding and size of the wound without increasing postoperative anal incontinence, recurrence and sepsis. JAFMC Bangladesh. Vol 19, No 1 (June) 2023: 47-49

Compartive Study between Conventional Laying-Open Technique with Sphincter Repair and Ligation of Intersphincteric Fistula Tract (LIFT) in Treatment of High Trans-Sphincteric Perianal Fistula

Abstract Background Complex anal fistula has been a hot topic in clinic. Many surgical techniques have been described for the treatment of such anal fistula, including the use of seton, fibrin glue, collagen plugs, rectal advancement flaps, fistulotomy with sphincter repair, and rerouting the fistula tract. However, the results have been variable, and no one procedure is superior to the others absolutely. It is worth our concern that the goal of any treatment procedure is to obliterate the tract and to have low recurrence rates while maintaining full continence. A fistulotomy lays open the fistulous tract, thus leaving smaller unepithelized wounds, which hastens the wound healing. Until now, fistulotomy is still the most widely used. But, the high cure rate is limited by the fact that laying open a transsphincteric fistula tract and cutting both the internal and the external sphincter has the risk of fecal incontinence ranging up to 40%. Objective To retrospectively evaluate the success rate, the recurrence and incontinence when using the Conventional laying-open and sphincter Repair technique in comparison to Ligation of Intersphincteric Fistula Tract (LIFT) for treating high trans-shpincteric perianal fistula. Patients and Methods This was a cohort retrospective, comparative study that was conducted on cases of fistula in the anus, who were subjected to surgery in Ain Shams University Hospitals and Ain shams specialized hospitals in the period from October 2021 to March 2022 (at least 30 cases) to evaluate the success rate, the recurrence rate, and incontinence rate when using the conventional laying open with sphincter repair technique compared to ligation of inter-sphincteric fistula tract (LIFT) For High trans-sphincteric perianal fistula. Results Regarding Relation of recurrence with demographic data of the studied patients, de novo/recurrent, Wexner score before and after operation and complications. that there was no statistically significant relation found recurrence with demographic data of the studied patients, de novo/recurrent, Wexner score before and after operation while there was statistically significant relation found with complications. Conclusion LIFT procedure is an effective and preferred sphincter-saving technique for fistula-inano with shorter healing time and lower incidence of postoperative anal incontinence, but have higher incidence of recurrence as compared to conventional layopen with sphincter repair which have a lower incidence of recurrence but have a relatively longer Healing time and higher incidence of postoperative anal incontinence. Both techniques are effective, have post operative good results and safe in treatment of high transsphincteric perianal fistula but Further research work is still warranted to confirm the long term outcome of these 2 techniques with a larger sample size and a longer follow up period. To know which technique is superior over the other.

Functional state of the obturator apparatus of the rectum after surgical treatment of grade 4 ­hemorrhoids with an ultrasonic scalpel

Background. Despite the improvement of surgical techniques for the treatment of chronic hemorrhoids, the problem of incontinence of the components of the intestinal contents in the postoperative period remains relevant.&#x0D; Aim. Evaluation of the functional state of the rectal obturator in patients with grade 4 hemorrhoids before and after surgical treatment with an ultrasonic scalpel.&#x0D; Material and methods. At the National Medical Research Centre for Coloproctology named after A.N. Ryzhikh of the Ministry of Health of Russia, 500 patients with grade 4 hemorrhoids operated on with an ultrasonic scalpel for the period 20152017 were examined using anorectal manometry (profilometry). The mean age of the patients was 49.212.4 years (from 22 to 65 years). At the same time, initially, 11/500 (2.2%) patients even before the operation had periodic complaints of gas incontinence (grade I anal sphincter insufficiency; 2.51.3 points on the Wexner scale). For statistical processing, the Student's t-test or the nonparametric single-sample Wilcoxon criterion were used.&#x0D; Results. On average, manometric indicators for the group before surgery were within the physiological norms. In 11 patients with complaints of incontinence, the pressure in the anal canal was initially reduced both at rest and during volitional contraction. At the same time, among the rest of the patients without any complaints of incontinence, 55/489 (11.2%) cases of subclinical (without manifestations) form of anal incontinence were identified only by a decrease in the manometric indicators of the sphincter rest tone, which made it possible to refer these patients to the group risk for the development of postoperative anal incontinence. After surgery, clinical complaints of gas incontinence appeared in 14/55 (25.5%) patients with subclinical anal sphincter insufficiency. In total, by the 45th day, anal incontinence according to complaints and the results of an objective study was registered in 25/500 (5.0%) patients.&#x0D; Conclusion. Clinical and instrumental signs of anal sphincter insufficiency after surgical treatment of stage 4 hemorrhoids with an ultrasonic scalpel were registered in 5.0% of cases, while in 2.2% they were at baseline (in patients with a decrease in intraanal pressure and complaints), and in 2,8% appeared after surgery (in patients with subclinical anal incontinence).

Comparison of anal dilatation versus no dilatation with a standardized dilator in reducing pain after hemorrhoidectomy: a randomized control trial

BackgroundPost-operative pain is the main problem of hemorrhoidectomy. An adequate pain management can promote early mobilization, fast recovery, and reduce hospitalization costs. This study aimed to investigate the role of preoperative anal dilatation using a standardized anal dilator in reducing post-operative pain.MethodThis study was conducted using randomized prospective trial with a total of 40 subjects, who were divided into 2 groups. The first group received preoperative anal dilatation using a 33 mm anal dilator for 20 min, while the second group did not. The post-operative anal pain, edema, bleeding, and incontinence were observed in the first, second, and seventh day.ResultThe post-operative pain was significantly lower in the preoperative anal dilatation group for all days of observation (p < 0.05). The difference of post-operative bleeding and edema between groups were not significant. Fecal incontinence was initially significantly higher in the preoperative anal dilatation group, but the difference was insignificant at the seventh day (p = 0.500).ConclusionPreoperative anal dilatation significantly reduced post-operative pain. The side effect of fecal incontinence was only temporary until the seventh day after surgery.Trial Registration This trial was registered on Thai Clinical Trials Registry (TCTR) with TCTR identification number TCTR20220314002, on 14/03/2022 (retrospectively registered).

Therapeutic outcome of lateral internal sphincterotomy in the treatment of chronic anal fissures

Introduction: Chronic anal fissure (CAF) is one of the most common proctologic conditions seen in surgery and is the most common cause of perianal pain. The surgical procedure of choice is lateral internal sphincterotomy (LIS) which usually provides a permanent cure for CAF. The fear of causing incontinence restricts many surgeons from performing LIS for managing CAF. The objective of our study is to evaluate the outcome of LIS in treating CAF in terms of fissure healing and reduction in resting anal pressure (RAP), as well as the incidence of anal incontinence following the procedure. Materials and Methods: A prospective study was conducted among 43 patients with CAF who underwent LIS. Anal manometry of the patients was done and results were noted preoperatively as well as at 6 weeks postoperatively. Patients were followed up and symptom relief, healing of fissure and incontinence to flatus or stool if present were noted on post-operative day, 1 week after surgery and 6 weeks after surgery. Results: Fissure healed in all 43 patients who underwent LIS in our institute. Hence, we observed a 100% healing rate following the procedure. RAP was found to be raised in all patients with CAF who required surgical treatment with a mean pre-operative RAP of 86.6 mmHg (normal 40–60 mmHg.). There was a significant reduction in RAP after the LIS surgery with a P < 0.001. The mean post-operative RAP was 53.16 mmHg which is in the normal range. Only one patient (2.3%) developed post-operative anal incontinence in our study. He was also managed conservatively with no permanent incontinence. Conclusions: We conclude that LIS is the surgical treatment of choice for CAFs, as it gave a 100% healing rate with a very low incidence of post-operative anal incontinence and other complications.

Comparison of Open Haemorrhoidectomy and Stapled Haemorrhoidopexy: A Hospital- based Prospective Study

Introduction: Open Haemorrhoidectomy (OH) is a widely used procedure. While as a novel technique, Stapled Haemorrhoidectomy (SH) is gaining worldwide recognition for its benefits, regarding treatment procedures for Haemorrhoids or piles. Aim: To compare SH technique with OH technique on the basis of postoperative parameters including pain, resumption of daily activity, hospital stay, postoperative bleeding, urinary retention and anal incontinence. Materials and Methods: This hospital-based, prospective study was conducted in Department of Surgery at SCL Hospital, Saraspur, Ahmadabad, Gujarat, India, from August 2017 to July 2018. The study included 80 patients between the age group of 20 and 70 years, diagnosed to have grade III or IV haemorrhoids. The patients were divided into two groups. Group OH included patients undergoing open haemorrhoidectomy (n=40) and Group SH included patients undergoing stapled haemorrhoidectomy (40 patients). Postoperatively, patients of both groups were reviewed at the time of discharge. All patients were given a questionnaire and data collected verbally and analysed statistically. Comparative analysis between the two groups was done based on Student’s t-test. Results: Out of the total 80 patients, 36(90%) were males and 4(10%) females in OH group whereas 35(87.5%) were males and 5(12.5%) females in SH group. The mean age of patients in the OH group was 42.2 years, while for SH the mean age was 38.5 years. In both groups, postoperative anal incontinence was not seen. Based on independent Student’s t-test, the postoperative pain (p-value=0.024), postoperative hospital stay (p-value=0.032) and duration of resumption of daily activity (p-value=0.003) parameters found to be significantly lesser in SH group as compared to OH group. However, complications observed were comparable in both the groups like postoperative bleeding, urinary retention, and anal incontinence. Conclusion: Stapled Haemorrhoidopexy is safe procedure with number of advantages in terms of short operative time and less post op complications. However, as far as recurrence rate assessment in SH technique is concerned, long term follow-ups are required.

Results of treatment of postoperative anal incontinence with volume-forming gel "noltrex"

Results of treatment of postoperative anal incontinence with volume-forming gel "noltrex"

Modified Gant procedure for treatment of internal rectal prolapse in elderly women.

BACKGROUNDAlthough rectal prolapse is not a life-threatening condition, it can cause defecation disorders, anal incontinence, sensory abnormalities, and other problems that can seriously affect quality of life.AIMTo study the efficacy of the modified Gant procedure for elderly women with internal rectal prolapse.METHODSSixty-three elderly female patients with internal rectal prolapse underwent the modified Gant procedure. The preoperative and postoperative anal symptoms, Patient Assessment of Constipation Quality of Life (PAC-QOL), Wexner incontinence score, incontinence quality of life score, and complications (massive hemorrhage, infection, anorectal stenosis, and anorectal fistula) were compared.RESULTSThe improvement rates of postoperative symptoms were defecation disorders (84.5%), anal distention (69.6%), defecation sensation (81.4%), frequent defecation (88.7%), and anal incontinence (42.9%) (P < 0.05). All dimensions and total scores of the PAC-QOL after the procedure were lower than those before the operation (P < 0.05). The postoperative anal incontinence score and Wexner score were significantly lower than those before the procedure (P < 0.05). The quality of life and total scores of postoperative anal incontinence were significantly higher than those before the procedure (P < 0.05). There were no serious complications and no deaths.CONCLUSIONThe modified Gant procedure has significant advantages in the treatment of elderly women with internal rectal prolapse.

ЛЕЧЕНИЕ АНАЛЬНОЙ ИНКОНТИНЕНЦИИ С ОБЪЕМОБРАЗУЮЩИМ ГЕЛЕМ «NOLTREX»

The article presents the results of treatment of 27 patients aged 3 to 18 years with a diagnosis of postoperative anal incontinence. Who performed the operation of gel plastic surgery of the anal canal with polyacrylamide gel "Noltrex". Morphological studies were carried out on 10 labarotor mice, body weight 20-22 grams, in the department of experimental biomodelling. The analysis of the conducted studies showed that in 22 (78.3%) patients, after a single injection of the bulking polyacrylamide gel "Noltrex", complete closure of the anus was noted and normal continence was achieved. When choosing a tactic for the treatment of postoperative anal incontinence in children, an individual approach is required, taking into account the cause leading to this condition. Gel plasty of the anal canal in patients with postoperative anal incontinence is the method of choice and is an alternative to reconstructive plastic surgery. However, it should be noted that it is appropriate and effective in cases where there is no cicatricial change in the anal canal. Key words: anal incontinence, volume forming gel, proctoplasty, treatment

Modified procedure for prolapse and hemorrhoids: Lower recurrence, higher satisfaction

BACKGROUNDHemorrhoidal prolapse is a common benign disease with a high incidence. The treatment procedure for prolapse and hemorrhoids (PPH) remains an operative method used for internal hemorrhoid prolapse. Although it is related to less pos-operative pain, faster recovery and shorter hospital stays, the postoperative recurrence rate is higher than that of the Milligan-Morgan hemorrhoidectomy (MMH). We have considered that recurrence could be due to shortage of the pulling-up effect. This issue may be overcome by using lower purse-string sutures [modified-PPH (M-PPH)]. AIMTo compare the therapeutic effects and the patients’ satisfaction after M-PPH, PPH and MMH.METHODSThis retrospective cohort study included 1163 patients (M-PPH, 461; original PPH, 321; MMH, 381) with severe hemorrhoids (stage III/IV) who were admitted to The 2nd Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University from 2012 to 2014. Early postoperative complications, efficacy, postoperative anal dysfunction and patient satisfaction were compared among the three groups. Established criteria were used to assess short- and long-term postoperative complications. A visual analog scale was used to evaluate postoperative pain. Follow-up was conducted 5 years postoperatively.RESULTLength of hospital stay and operating time were significantly longer in the MMH group (8.05 ± 2.50 d, 19.98 ± 4.21 min; P < 0.0001) than in other groups. The incidence of postoperative anastomotic bleeding was significantly lower after M-PPH than after PPH or MMH (1.9%, 5.1% and 3.7%; n = 9, 16 and 14; respectively). There was a significantly higher rate of sensation of rectal tenesmus after M-PPH than after MMH or PPH (15%, 8% and 10%; n = 69, 30 and 32; respectively). There was a significantly lower rate of recurrence after M-PPH than after PPH (8.7% and 18.8%, n = 40 and 61; P < 0.0001). The incidence of postoperative anal incontinence differed significantly only between the MMH and M-PPH groups (1.3% and 4.3%, n = 5 and 20; P = 0.04). Patient satisfaction was significantly greater after M-PPH than after other surgeries.CONCLUSIONM-PPH has many advantages for severe hemorrhoids (Goligher stage III/IV), with a low rate of anastomotic bleeding and recurrence and a very high rate of patient satisfaction.M-PPH

Video-assisted anal fistula treatment combined with anal fistula plug for treatment of horseshoe anal fistula.

ObjectiveHorseshoe anal fistula is a common anorectal disease, and there is no standard procedure for its treatment. In this study, we performed a modified surgical procedure for the treatment of horseshoe anal fistula and investigated its efficacy and adverse effects.MethodsWe retrospectively analyzed the outcomes of video-assisted anal fistula treatment combined with an anal fistula plug (VAAFT-Plug) in 26 patients with a horseshoe anal fistula. The follow-up period ranged from 6 to 18 months. Preoperative and postoperative data were collected to analyze the cure rate, anal sphincter function, and incidence of complications.ResultsThe surgeries were successfully performed in all patients, 23 of whom were cured (effective cure rate of 88.46%). Three patients developed recurrence and were cured after traditional surgery. No patients developed severe complications or postoperative anal incontinence. The VAAFT-Plug protocol was performed with a small incision in the fistula that subsequently promoted fistula healing and preserved sphincter function.ConclusionAlthough randomized controlled trials will be needed to fully validate these findings, our results suggest that VAAFT-Plug represents a promising treatment strategy for horseshoe anal fistulas. This technique preserves normal anal function and achieves satisfactory outcomes in most patients.

Fissurectomy and anoplasty in posterior normotensive chronic anal fissure.

Purpose:Anal Fissure (AF) is the second most frequent proctological disease in Italy. Chronic AF (CAF) most common located at the posterior anal commissure (CAPF). CAPF are thought to be associated with hypertonic internal anal sphincter (IAS) but manometric findings showed that a normotonic IAS is present in the 20-40%. Sphincterotomy is often recommended as treatment of choice for CAF independently from IAS tone; nevertheless, this approach appears less logical for CAF with normotonic IAS, as in those cases there’s a higher risk of post-operative anal incontinence. The aim of this study is to evaluate the results of fissurectomy and anoplasty with V-Y cutaneous advancement flap, as treatment for patients suffering from CAPF without hypertonic IAS.Methods:We enrolled 30 patients affected by CAPF without IAS hypertonia. All patients were followed up for 2 years after the surgical procedure, with evaluation of anal continence, recurrence rate and maximum resting pressure, maximum squeeze pressure, ultraslow wave activity.Results:All patients healed within 40 days after surgery. We didn’t observe any “de novo” post-operative anal incontinence cases. We reported 2 cases of recurrences, within 18 months from surgery, all healed after conservative therapy. We didn’t record statistically significant differences in pre- and post-operative manometry findings.Conclusion:At 2 years after the surgical procedure we achieved good results, these evidences shows that sphincter preserving procedures are more suitable for CAPF without hypertonic IAS.

Comparative study between intersphinecteric ligation of perianal fistula versus conventional fistulotomy with or without seton in the treatment of perianal fistula: A prospective randomized controlled trial

BackgroundFistula-in-ano is one of the most common benign anal conditions in daily surgical practice.The goals in the treatment of an anal fistula are to eradicate sepsis and to eliminate the primary fistula opening, any associated tracts, and any secondary openings without a change in continence. Conventional fistulotomy (lay open of the fistula tract) is a commonly used procedure and is still relied on by the majority of surgeons as the gold standard for the treatment of perianal fistula. Ligation of the Intersphincteric Fistula Tract (LIFT) is a new sphincter-preserving technique for the treatment of anal fistula. ObjectiveTo compare the efficacy of open fistulotomy and ligation of intersphincteric fistula tract (LIFT) procedure based on its post-operative outcomes. Patients and methodsThe Present study is A prospective randomized controlled trial which included 30 patients presented with low transsphincteric perianal fistula 27 (90%) males and 3 (10%) females divided into two groups each group consisted of 15 patients. Group, I subjected to inter sphincteric ligation of perianal fistula (LIFT) procedure. Group II patients subjected to conventional fistulotomy. The study lasts 2 years from May 2017 to May 2019 with Follow up for 6 months duration. Operative time in our study was significantly higher in group (I) Managed by LIFT with a mean of 32.53 min than group (II) managed by fistulotomy with a mean of 20.87mins. Wound healing was faster in a group (I) managed by LIFT than group (II) managed by fistulotomy, as the mean time for complete wound healing was (4.53) weeks after LIFT and (5.67) weeks after fistulotomy. ResultsThere was no case of incontinence after performing the LIFT technique in all our patients in group I. there were 2 cases of incontinence to gases only after fistulotomy in group II. The healing rate after LIFT was 80% (12/15 patients). The healing rate after fistulotomy was 93.3% (14/15 patients). ConclusionLIFT procedure is an effective and preferred sphincter-saving technique for fistula-in-ano with shorter healing time and lower incidence of postoperative anal incontinence, as compared to open fistulotomy.

Fisurectomy and anoplasty with botulinum toxin injection in patients with chronic anal posterior fissure with hypertonia: a long-term evaluation

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.

BOTULINUM TOXIN TYPE A AND LATERAL SUBCUTANEOUS SPHINCTEROTOMY FOR CHRONIC ANAL FISSURE WITH THE SPHINCTER SPASM. WHAT TO CHOOSE? (systematic literature review and meta-analysis)

INTRODUCTION: for the treatment of chronic anal fissure, various surgical techniques are used, the main difference between which is the method of eliminating the anal sphincter spasm. One of the most serious postoperative complications is the development of anal incontinence. To date, there are a number of methods for drug-induced relaxation of the internal sphincter, which can significantly reduce the risk of developing anal incontinence after surgery.AIM: to evaluate the safety and effectiveness of botulinum toxin type A (BTA) and lateral subcutaneous sphincterotomy (LSS) in the treatment of chronic anal fissure with sphincter spasm.METHODS: a systematic review and meta-analysis of 7 selected randomized clinical trials comparing the results of treatment of chronic anal fissure using BTA and LSS was performed. The results of treatment of 489 patients were analyzed with an assessment of the following indicators: the incidence of epithelization of fissures, postoperative complications, development of anal incontinence and the disease recurrence. RESULTS: In the BTA group, the incidence of fissure epithelization is 0.88 times lower than in the LSS group (OR=0.12; CI=0.06;0.22; p&lt;0.00001). There were no statistical differences in the rate of postoperative complications in both groups (OR=1.07; CI=0.50;2.30; p=0.85). The risk of developing postoperative anal incontinence is 0.86 times lower in the BTA group than in the LSS group (OR=0.14; CI=0.03;0.64; p=0.01). The risk of relapse after lateral subcutaneous sphincterotomy is 6.06 times lower than when using botulinum toxin type A (OR=6.06; CI=3.52;10.42; p&lt;0.00001).CONCLUSION The use of botulinum toxin type A in the treatment of chronic anal fissure reduces the risk of developing postoperative anal incontinence, but this method is significantly inferior to lateral subcutaneous sphincterotomy in terms of the rate of chronic anal fissure epithelization.

Treatment of complex trans- and extrasphincteric fistulas by laser thermo-obliteration of fistula tract: preliminary results

The aim of this study was to assess the preliminary results of treatment of patients with complex transand extrasphincteric fistulas by laser thermo-obliteration of fistula tract. Materials and methods. The analysis was conducted on 28 patients with complex trans- and extrasphincteric fistulas (24 males and 4 females). The age of patients ranged from 29 to 68 years (on the average 43±12.4). In 8 (28.6 %) patients there were extrasphincteric fistulas, in 20 (71.4 %) — transsphincteric fistulas. The minimum assess period at which healing or preservation of the fistula was diagnosed was 2 months after the surgery. Results. The average period of follow-up was 3.5±4.9 (0.5–14) months. Control examination in terms of 2 months or more after the procedure was carried out in 20/28 (71.4 %). The primary healing rate was 9/20 (45 %). Of these, 7 (77.8 %) patients had transsphincteric fistulas and 2 (22.2 %) patients had extrasphincteric. The disease reccurred in 11 (55 %) of the 20 supervised patients. There was no cases of the development of anal incontinence after the operation. Conclusion. Laser thermo-obliteration of the fistula tract is a mini-invasive, sphincter-preserving method, which is indicated in patients with complex fisulas, in cases where traditional operation is associated with a high risk of postoperative anal incontinence. However, to obtain more reliable results, further patient recruitment and assessment of long-term treatment results are required.

Anal function and quality of life analysis after laparoscopic modified Parks for ultra-low rectal cancer patients

BackgroundTo assess postoperative anal function and quality of life of ultra-low rectal cancer patients treated by laparoscopic modified Parks surgery.MethodsFrom February 2017 to March 2019, 114 patients with ultra-low rectal cancer above T2 were treated respectively with ultra-low anterior resection (Dixon), modified coloanal anastomosis (modified Parks), and Miles according to the preoperative stage and anastomotic position. The postoperative anal function and Fecal Incontinence Quality of Life Scale (FIQL) of each patient were collected and synthetically analyzed.ResultsCompared with the Dixon group, the postoperative anal function and FIQL in the Parks group were poor at the early stage. However, from 6 to 12 months after surgery, the scores of anal function and FIQL in the Parks group were similar to those in the Dixon group (P > 0.05). Compared with the Miles group, the FIQL of the two groups were similar in the early postoperative stage. However, with the passage of time, from 3 to 9 months after surgery, the four domains of FIQL in the Parks group were higher than those in the Miles group successively (P < 0.05).ConclusionsLaparoscopic modified Parks is a safe, effective, and economical anus-preserving surgery. Although its early anal function and FIQL were poor, it could gradually recover to the similar level as Dixon. Moreover, it can save the anus and obtain a better postoperative quality of life for some patients who previously could only undergo Miles.

Early and late effects of the sequential transfixed stich technique for the treatment of the symptomatic rectocele without rectal mucosa prolapse.

Different surgical techniques have been proposed for rectocele repair. However, controversial aspects exist on the best approach to use. The study aims to report the early and late outcomes of the sequential transfixed stich technique (STST) for the treatment of rectocele in the absence of mucosal prolapse. One hundred patients presenting a symptomatic rectocele were treated with STST from January 2010 through August 2015. Patients with mucosal prolapse were not considered eligible for STST. After a period of 24 months from surgery, all the patients were clinically evaluated with the intent to investigate the risk of recurrence of the preoperative symptoms. All the patients were women (median age=54.7 years; ranges=37-75). Median discharge time was 1.5 days. One-month severe complications were: hemorrhoid thrombosis (6.0%), self-solved bleeding (6.0%), urinary retention (4.0%), anal secretion (4.0%) and urinary incontinence (1.0%). No post-operative cases of fecal incontinence were observed. Two years after surgery, 76.0% of patients reported a global improvement of the preoperative symptoms, with 73 and 35% of cases showing a reduced difficulty in the evacuation and need for digitation. Only 8.0% of patients showed a recurrence of the initial symptoms. The STST is a feasible, safe, and cost-effective technique for the treatment of the rectocele without rectal mucosal prolapse. The method does not increase the risk of postoperative anal incontinence and presents a short hospital stay. STST presents long-term results in line with other transvaginal and transanal approaches.