Results Of Anorectal Manometry Research Articles

307 - Correlation of Early Postpartum Anal/Faecal Incontinence with Endoanal Ultrasound, Digital Rectal Examination, Machine Learning-supported Electric Impedance Spectroscopy, and High-Resolution Anorectal Manometry Results: Exploratory Results from a Prospective, Comparative, Multicentre Clinical Study

307 - Correlation of Early Postpartum Anal/Faecal Incontinence with Endoanal Ultrasound, Digital Rectal Examination, Machine Learning-supported Electric Impedance Spectroscopy, and High-Resolution Anorectal Manometry Results: Exploratory Results from a Prospective, Comparative, Multicentre Clinical Study

Clinical manifestations and quality of life in patients with different types of idiopathic megabowel

AIM: to compare the clinical and diagnostic features and quality of life in patients with different types of idiopathic megabowel. PATIENTS AND METHODS: 157 patients with idiopathic megacolon/megarectum, confirmed by barium enema, were divided on 3 groups: 1) distal idiopathic megabowel (megarectum ± distal third of sigmoid colon dilatation); 2) idiopathic megacolon (variable extent of colon dilatation with a normal size rectum); 3) idiopathic megabowel (megarectum ± variable extent of colon dilatation). Hirschsprung’s disease was excluded in all patients based on complex of clinical features, barium enema and anorectal manometry results and (if needed) rectal Swenson’s biopsy. RESULTS: the cohort included 70 (44.6 %) patients with distal idiopathic megabowel, 50 (31.8 %) patients with idiopathic megacolon and 37 (23.6 %) patients with idiopathic megabowel. Wexner constipation scale rate, rate of integral parameters “abdominal discomfort” and “defecation difficulties”, summary assessment of quality of life by IBSQOL questionnaire did not differ between groups (p > 0.05). At the same time patients with distal idiopathic megabowel were statistically significant younger (p < 0.01), had significant higher rate of faecal incontinence due to faecal impaction overflow (p < 0.01), had less often bowel movement. Also these patients had significant higher rate of distal contrast retention (p < 0.01) during gut transit test, but their colonic transit time was slight faster (p = 0.04).In multivariate analysis both megarectum (OR = 25.42; 95 % CI 5.01–128.92) and insufficiency of anal sphincter (OR = 4.71; 95 % CI 1.38–16.14) were independent predictors of faecal incontinence. The surgical treatment was performed most often in idiopathic megacolon group (p < 0.01), mainly due to colon volvulus. The most patients with distal idiopathic megabowel (97.1 %) were successfully maintained with a conservative treatment. CONCLUSION: there was not substantial difference in clinical features and quality of life in patients with different types of idiopathic megabowel, except of significant higher rate of faecal incontinence and less often bowel movement in distal idiopathic megabowel group. Faecal incontinence in these patients is linked disturbance rather intestinal, than anal component of continence. The necessity in surgical treatment was rising most often in cases of idiopathic megacolon. The conservative treatment was quite effective in most patients with distal idiopathic megabowel.

Latent profile analysis reveals the central role of psychological symptoms in driving disease severity in chronic constipation.

Chronic constipation (CC) is defined by symptom criteria reflecting heterogenous physiology. However, many patients with CC have significant psychological comorbidities-an alternative definition using a biopsychosocial classification model could be warranted to inform future treatments. We sought to: (1) empirically derive psychological symptom profiles of patients with CC using latent profile analysis and (2) validate these profiles by comparing them on symptom severity, GI-specific anxiety, body mass index (BMI), and anorectal manometry findings. Participants included adults presenting for anorectal manometry for CC (N = 468, 82% female, Mage = 47). Depression/anxiety symptoms and eating disorder (ED) symptoms (EAT-26) were used as indicators (i.e., variables used to derive profiles) representing unique psychological constructs. Constipation symptoms, GI-specific anxiety, BMI, and anorectal manometry results were used as validators (i.e., variables used to examine the clinical utility of the resulting profiles). A 5-profile solution provided the best statistical fit, comprising the following latent profiles (LPs): LP1 termed "high dieting, low bulimia;" LP2 termed "high ED symptoms;" LP3 termed "moderate ED symptoms;" LP4 termed "high anxiety and depression, low ED symptoms;" and LP5 termed "low psychological symptoms." The low psychological symptom profile (61% of the sample) had lower abdominal and overall constipation severity and lower GI-specific anxiety compared to the four profiles characterized by higher psychological symptoms (of any type). Profiles did not significantly differ on BMI or anorectal manometry results. Profiles with high psychological symptoms had increased constipation symptom severity and GI-specific anxiety in adults with CC. Future research should test whether these profiles predict differential treatment outcomes.

Mesorectal reconstruction with pedicled greater omental transplantation to relieve low anterior resection syndrome following total intersphincteric resection in patients with ultra-low rectal cancer

BackgroundTotal intersphincteric resection (ISR) is the ultimate anus-preserving surgery for patients with ultra-low rectal cancer (ULRC), which can result in various degrees of anorectal dysfunction. Known as low anterior resection syndrome (LARS), it seriously affects the postoperative quality of life of patients. The aim of this study was to discuss the value of mesorectal reconstruction with pedicled greater omental transplantation (PGOT) to relieve LARS following total ISR in patients with ULRC, hoping to provide new ideas and strategies for the prevention and improvement of LARS.MethodsWe retrospectively analyzed hospitalization data and postoperative anorectal function of 26 ULRC patients, who were met inclusion and exclusion criteria in our center from January 2015 to February 2022. And combined with the results of anorectal manometry and rectal magnetic resonance imaging (MRI) defecography of some patients, we assessed comprehensively anorectal physiological and morphological changes of the patients after surgery, and their correlation with LARS.ResultsIn this study, 26 patients with ULRC were enrolled and divided into observation group (n = 15) and control group (n = 11) according to whether PGOT was performed. There were no significant differences in surgical results such as operative time, intraoperative blood loss and postoperative complications between the two groups (P > 0.05). Postoperative follow-up showed that patients in both groups showed severe LARS within 3 months after surgery, but from the 3rd month after surgery, LARS in both groups gradually began to decrease, especially in the observation group, which showed faster recovery and better recovery, with statistically significant difference (P < 0.001). Through anorectal manometry, the mean rectal resting pressure in the observation group was significantly lower than that in the control group (P = 0.010). In addition, the postoperative thickness of the posterior rectal mesenterium in the observation group was significantly higher than that in the control group (P = 0.001), and also higher than the preoperative level (P = 0.018). Moreover, rectal MRI defecography showed that the neo-rectum had good compliance under the matting of greater omentum, and its intestinal peristalsis was coordinated.ConclusionsULRC patients, with the help of greater omentum, coordinated their neo-rectum peristalsis after total ISR and recovery of LARS was faster and better. PGOT is expected to be an effective strategy for LARS prevention and treatment of ULRC patients after surgery and is worthy of clinical promotion.

Post-Operative Anorectal Manometry in Children following Anorectal Malformation Repair: A Systematic Review.

Despite surgical correction, children with anorectal malformations may experience long-term bowel dysfunction, including fecal incontinence and/or disorders of evacuation. Anorectal manometry is the most widely used test of anorectal function. Although considerable attention has been devoted to its application in the anorectal malformation cohort, there have been few attempts to consolidate the findings obtained. This systematic review aimed to (1) synthesize and evaluate the existing data regarding anorectal manometry results in children following anorectal malformation repair, and (2) evaluate the manometry protocols utilized, including equipment, assessment approach, and interpretation. We reviewed four databases (Embase, MEDLINE, the Cochrane Library, and PubMed) for relevant articles published between 1 January 1985 and 10 March 2022. Studies reporting post-operative anorectal manometry in children (<18 years) following anorectal malformation repair were evaluated for eligibility. Sixty-three studies were eligible for inclusion. Of the combined total cohort of 2155 patients, anorectal manometry results were reported for 1755 children following repair of anorectal malformations. Reduced resting pressure was consistently identified in children with anorectal malformations, particularly in those with more complex malformation types and/or fecal incontinence. Significant variability was identified in relation to manometry equipment, protocols, and interpretation. Few studies provided adequate cohort medical characteristics to facilitate interpretation of anorectal manometry findings within the context of the broader continence mechanism. This review highlights a widespread lack of standardization in the anorectal manometry procedure used to assess anorectal function in children following anorectal malformation repair. Consequently, interpretation and comparison of findings, both within and between institutions, is exceedingly challenging, if not impossible. Standardized manometry protocols, accompanied by a consistent approach to analysis, including definitions of normality and abnormality, are essential to enhance the comparability and clinical relevance of results.

Colonic Slow Transit in Patients with Dyssynergic Defecation and Effectiveness of Biofeedback Therapy

Background: Colonic transit is delayed in two-thirds of patients with dyssynergic defecation. As a result, it's possible that dyssynergic defecation and slow transit constipation are linked. There is a scarcity of research on the coexistence of dyssynergic defecation and slow transit constipation, as well as the efficacy of biofeedback therapy in this group of patients. &#x0D; &#x0D; Methods: The results of anorectal manometry and MR defecography were used to make the diagnosis of dyssynergic defecation. The colon transit time was measured with the help of 24 specially marked markers. All of the patients were given biofeedback therapy. &#x0D; &#x0D; Results: The average age of the 17 patients with dyssynergic defecation in the study was 45.6 years. The colon transit time was prolonged in seven patients (41.2%). In anorectal manometry, 7 patients (41.2%) had improved dyssynergic defecation after dyssynergic defecation. When the relationship between colon transit time and biofeedback therapy was investigated, it was discovered that normal colon transit time was found in 85.7 percent of those who benefited from biofeedback therapy, while slow transit constipation was found in 60% of those who did not. &#x0D; &#x0D; Conclusion: In patients with pre- biofeedback therapy and dyssynergic defecation, colon transit time should be evaluated, and it should be kept in mind that these patients may be resistant to treatment in the case of accompanying slow transit constipation.

Effect of pelvic peritoneum reconstruction on the prognosis of patients underwent laparoscopic low anterior resection of rectal adenocarcinoma

Objective: To investigate the effect of pelvic peritoneum reconstruction on the prognosis of patients underwent laparoscopic low anterior resection of rectal adenocarcinoma. Methods: This retrospective cohort study included 97 patients who underwent laparoscopic low anterior resection of rectal adenocarcinoma in General Surgery Department, the First Affiliated Hospital of Soochow University from January 2017 to June 2021. According to the implementation of pelvic peritoneum reconstruction, the subjects were divided into study group (48 patients underwent pelvic peritoneum reconstruction after laparoscopic resection) and control group (49 patients not underwent pelvic peritoneum reconstruction). The two groups were compared in terms of Wexner score of anal function, anorectal manometry results, normal rate of defecation sensation, pelvic floor anatomical structure and postoperative complications. Five-year survival analysis was performed. Results: Patients in the study group and the control group were (61.25±10.38) years old and (59.47±11.40) years old (P>0.05). The proportions of male patients were 60.4% (29 cases) and 55.1% (27 cases) (P>0.05) in the study group and control group, respectively. At 3, 6 and 12 months after surgery, Wexner scores of anal function in the study group were lower than those in the control group [(14.29±2.07) vs (16.33±2.18), P<0.001; (9.57±2.34) vs (11.26±2.85), P=0.002; (5.41±1.36) vs (7.86±1.95), P<0.001, respectively]. The anal resting pressure and anal systolic pressure of the study group were higher than those of the control group [(56.29±7.31) mmHg vs (52.88±6.65) mmHg, P=0.018; (129.33±17.36) mmHg vs (110.45±15.22) mmHg, P<0.001, respectively] (1 mmHg=0.133 kPa). The rectal sensory volume, rectal maximum tolerance volume, and the length of anal high-pressure area in the study group were greater than those in the control group [(32.15±4.38) vs (29.76±4.29), P=0.008; (209.57±40.27) vs (184.39±37.56), P=0.002; (3.07±0.52) vs (2.80±0.49), P=0.010, respectively]. At 3 and 6 months after surgery, the normal rates of defecation sensation in the study group were 47.9% (23 cases) and 70.8% (34 cases), respectively, higher than those in the control group [26.5% (13 cases) and 51.0% (25 cases)] (P=0.029 and 0.046, respectively). The detection rate of intestinal tube accumulation in the study group was lower than that in the control group [12.5% (6 cases) vs 38.9% (19 cases)] (P=0.003). There was no significant difference in the total incidence of complications (anastomotic leakage, abdominal infection, intestinal obstruction, pendant pneumonia and urinary tract infection) between the two groups [18.8% (9 cases) vs 24.5% (12 cases)] (P=0.493). There was no significant difference in 5-year cumulative survival rate between the study group and the control group (71.6% vs 68.2%, P=0.309). Conclusion: Pelvic peritoneum reconstruction can improve postoperative anal function and reduce intestinal tube accumulation in patients underwent laparoscopic low anterior resection of rectal adenocarcinoma with high safety and feasibility.

Post-operative anorectal manometry in children with Hirschsprung disease: A systematic review.

Hirschsprung disease is commonly encountered by pediatric surgeons. Despite advances in the surgical management, these children may experience symptoms of bowel dysfunction throughout adulthood. Anorectal manometry may be used to assess post-operative anorectal structure and function. This review aimed to consolidate and evaluate the literature pertaining to post-operative findings of anorectal manometry in children with Hirschsprung disease. (1) Synthesize the available data regarding anorectal motility patterns in children following repair of Hirschsprung disease. (2) Evaluate the reported anorectal manometry protocols. We performed a systematic review of four databases: Embase, MEDLINE, the Cochrane Library, and PubMed. This systematic review was performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Studies reporting results of post-operative anorectal manometry in children with Hirschsprung disease were evaluated for inclusion. Twenty-three studies satisfied inclusion criteria, with a combined cohort of 939 patients. Post-operative anorectal manometry results were reported for 682 children. The majority of included studies were assessed as "poor quality." Disparate manometry protocols, heterogeneous cohorts, and lack of standardized outcome assessments introduced a risk of outcome reporting bias, limited the comparability of results, and impeded clinical translation of findings. This systematic review demonstrated the lack of high-quality evidence underlying the current understanding of post-operative anorectal motility in children with HD. There was little consistency in reported manometry outcomes between studies. In future work, emphasis must be placed on the application of standardized manometry protocols, cohort reporting, and patient outcome assessments.

EVALUATING EXPERIENCE WITH ANORECTAL MANOMETRY IN AN OUTPATIENT SETTING

Purpose of the study: 1) Evaluating application of anorectal manometry in an outpatient setting. 2) Determination of reference manometric and point criteria for normal rectal sphincter indicators and Fecal Incontinence (FI) according to anorectal manometry data using a Peritron anal sensor. Materials and methods: The retrospective study was based on the results of anorectal manometry using Peritron equipment (Cardio Design Pty Ltd, Australia) on 1200 patients with various proctological diseases, who were examined and treated at the Center for Outpatient Proctology of the surgical department of Railway Clinical Hospital (Rostov-on-Don, Russia) from 2015 to 2020. All patients were divided into 4 groups in accordance with the clinical classification of Fecal Incontinence (FI) developed at the National Coloproctology Research Center and the obtained results. As a subjective assessment, the Cleveland Fecal Incontinence Scale (Wexner) was used, and objectively, the results of anorectal manometry using the Peritron sphinctometer. Results: Our manometric data enabled to develop a reliable indicator scale of normal sphincter function and various degrees of fecal incontinence according to the Peritron findings and allowed to recommend the device for a wider introduction into clinical practice, in particular in coloproctology, to perform anorectal manometry.

Effects of Neoadjuvant Chemio-Radiation Therapy on the Anal Sphincter Function in Patients with Low Rectal Cancers

The aim of the study was to compare functional results prior to and following neoadjuvant chemoradiation therapy.Materials and methods. An analysis of the functional results of a prospective clinical study was carried out. The study included 90 patients who underwent low anterior rectal resection for cancer of the lower or middle ampullar rectum with T1-4aN0-2M0 using various reconstruction methods.Results and discussion. Group A included 22 patients with J-shaped reservoirs; group B — 30 patients with side-to-end anastomoses; group C — 38 patients with end-to-end anastomoses. Out of the total study group (n = 90), 43 patients underwent neoadjuvant chemoradiotherapy vs. 47 patients without any preoperative treatment. No statistically significant difference was observed in the frequency of applied reconstructive techniques (р = 0.725) and the incidence of postoperative complications (p = 0.103) in the groups with and without neoadjuvant chemoradiotherapy. The baseline scores of the Wexner scale and the results of anorectal manometry in the comparison groups were comparable (p &gt; 0.05). However, upon completion of neoadjuvant chemoradiotherapy and during the period from the moment of surgery up to 12 months after the closure of preventive intestinal stomas, the functional results were less satisfactory in the group of patients having received neoadjuvant chemoradiotherapy (n = 43) with regard to the comparison group (n = 47). Nevertheless, a statistically significant difference in the results was observed from the end of neoadjuvant chemoradiotherapy up to 3 months after closure of the stoma (p &lt;0.05).Conclusions. Neoadjuvant chemoradiation therapy has a negative effect on the function of the anal sphincter, thus requiring concomitant therapy and physiotherapy both at the stages of neoadjuvant chemoradiotherapy and at long intervals after the main surgical stage.

Gastrointestinal Amyloidosis in Children with Familial Mediterranean Fever Disease and Anorectal Manometry Results

Objectives: The aim of this study was to evaluate the effect of amyloid deposition in colon mucosa on the results of anorectal manometry test and the use of ROME III questionnaire in patients with Familial Mediterranean Fever (FMF). Methods: The files of patients diagnosed with FMF were scanned to evaluate the patients at risk for amyloid deposition. Predisposing factors were identified. The patients were sampled using anorectal manometry test, Rome III questionnaire and the rectal mucosa suction biopsy and the test results were compared. Results: 17 (63%) of the patients were female and 10 (37%) were male. The mean age was 12.15 ± 2.40 years. The number of patients with amyloid deposition in the rectal mucosa sample was 2 (7.4%). Both of these patients had regularly used colchicine. Amyloid deposition was found to be high in patients with M694V homozygous mutation (P = 0.05). According to the Rome III questionnaire, findings suggestive of irritable bowel syndrome were found in 5 patients and abdominal migraine was found in 3 patients. However, no statistical difference was found when the results of the Rome III questionnaire were compared with the results obtained from the anorectal manometry test (P &gt; 0.05). Conclusions: Amyloidosis can be seen due to various environmental factors, regardless of age, even when colchicine is regularly used. Anorectal manometry is an easy to perform test, helping diagnosis in this patient group. Although it has been shown that in patients with predisposing factors for amyloid deposition RAIR can be detected at lower pressures in anorectal manometry, the clinical significance of this finding is unclear. Since the Rome III questionnaire showed findings consistent with functional abdominal pain disease in one third of the patients, independent of the presence of FMF, it was found that the application of this questionnaire in patients with FMF could be misleading.

Analysis on the technical characteristics and clinical efficacy of robotic-assisted intersphincteric resection for patients with low rectal cancer

Objective: To explore the technical characteristics and short-term clinical efficacy of robotic-assisted intersphincteric resection (ISR) for patients with low rectal cancer. Methods: A retrospective cohort study was used. Inclusion criteria: (1) rigid colonoscopy showed lower margin of the tumor ≤5 cm from the anal verge; (2) preoperative rectal MRI or endorectal ultrasound revealed staging T1-2, or T3 patients receiving concurrent chemoradiotherapy; (3) patients less than 70 years old with good function of anal sphincter before surgery; (4) no synchronous multiple primary carcinoma, and no distant metastasis; (5) the method of operation was agreed by the patient. Exclusion criteria: (1) T4 stage tumors; (2) sphincter dysfunction before operation; (3) recurrent tumors; (4) lower edge of tumors beyond the dentate line; (5) death due to non-rectal cancer during follow-up and unsatisfactory follow-up data. The clinical data of 21 patients with low rectal cancer meeting inclusion criteria undergoing robotic-assisted ISR at our department from January 2015 to June 2018 were collected. Parameters during and after operation were observed. Anorectal manometry was performed at 3, 6, and 12 months after the operation, and anal function was evaluated at 3, 6, and 12 months after the closure of the stoma by Kirwan classification and Wexner fecal incontinence score. The key steps of the operation are as follows: according to the principle of total mesorectal excision, the robot continued to enter into the levator ani hiatusdistally, and dissectin the sphincter space; according to the scope of sphincter resection, ISRwas divided into partial ISR, subtotal ISR, and total ISR; subtotal and total ISR usually needed to be combined with transanal pathway. The reconstruction of digestive tract was performed by double stapler anastomosis under laparoscope orhand-sewnanastomosis under direct vision, and preventive ileostomy was completed in the right lower abdomen. Results: Of 21 patients, 13 were male and 8 were female with mean age of (57.5±16.3) years. All the patients successfully completed the operation without conversion to laparotomy. Fourteen cases (66.7%) adopted partial ISR through complete transabdominal approach, 6 cases (28.6%) adopted the subtotal ISR through combined transabdominal and transanal approachs, and 1 case (4.8%) adopted the total ISR through the combined transabdominal and transanal approachs. The total operation time was (213.1±56.3) minutes, including (27.3±5.4) minutes for mechanical arm installation and (175.7±51.6) minutes for robotic operation. The amount of intraoperative hemorrhage was (62.8±23.2) ml, and no blood transfusion was performed in any patient. All patients underwent prophylactic ileostomy, and the stoma was closed 3-6 months after the operation. Except one case of anastomotic leakage, all other stomas were closed successfully. The postoperative hospitalization time was (7.6±2.2) days, and time to fluid intake was (3.3±0.9) days. One case of anastomotic leakage, one case of anastomotic stenosis, one case of inflammatory external hemorrhoids and one case of urinary retention occurred after surgery,and all of them were cured by conservative treatment. The mean diameter of tumors was (2.9±1.2) cm, and the number of harvested lymph node was 12.8 ± 3.3. In the whole group, the circumcision margin was negative, the proximal margin was (12.2 ± 2.1) cm, the distal margin was (1.1 ± 0.4) with all negative, and the R0 resection rate was 100%. The results of anorectal manometry showed that the preoperative rest pressure, rectal maximum squeeze pressure, initial sensory volume and maximum tolerated volume were (45.19±8.46) mmHg, (128.18±18.80) mmHg, (44.33±10.11) ml and (119.00±19.28) ml, respectively;these parameters reduced significantly 3 months after operation and they were (23.44±5.54) mmHg, (93.72±12.15) mmHg, (17.72±5.32) ml and (70.44±10.9) ml, respectively. The differences were statistically significant (all P<0.001). The resting pressure and the rectal maximum squeeze pressure returned to preoperative levels 12 months after operation, which were (39.33±6.64) mmHg and (120.58±16.47) mmHg, respectively (both P>0.05), while the initial sensory volume and the maximum tolerated volume failed to reach the preoperative state, which were (30.67±7.45) ml and (92.25±10.32) ml, respectively (both P<0.05). The patients were followed up for (22.1±10.6) months without local recurrence and distant metastasis. Eighteen patients were evaluated for anal function: Kirwan classification was grade I for 6 cases, grade II for 7 cases, grade III for 4 cases, and grade IV for 1 case; Wexner incontinence score was 8.6±0.8; 14 cases had good defecation control. Conclusion: The clinical efficacy of ISR with Da Vinci robot in the treatment of low rectal cancer is satisfactory.

Results of rectoanal manometry after a novel laparoscopic technique: laparoscope-assisted heart-shaped anastomosis for Hirschsprung's disease.

The present research utilizes a mid-term follow-up study to assess the results of anorectal manometry after laparoscope-assisted heart-shaped anastomosis (LHSA) for Hirschsprung's disease (HSCR), and compares it to a more generally applied approach, the laparoscope-assisted Soave procedure (LSP). Retrospectively, patients from January 2015 to June 2017 who received LHSA or LSP were included in this study. After surgery, anorectal manometry was performed by the outpatient department. Anal sphincter resting pressure, anal canal length, amplitude of anal contraction, and frequency of anal contraction pre- and postoperatively were recorded. Additionally, mid-term complications were also monitored. Preoperative manometry showed no statistically significant difference between the LHSA and LSP groups. Postoperatively, anal sphincter resting pressure was lower in the LHSA group (60.64 ± 9.33 vs. 68.84 ± 11.80mmHg, p = 0.001). Furthermore, anal canal length of the LHSA group was shorter than that of the LSP group (1.41 ± 0.18 vs. 1.53 ± 0.25cm, p = 0.015). Frequency of anal contraction also showed a statistically significant difference between the LHSA and LSP groups (13.53 ± 2.17 vs. 12.50 ± 2.03 per minute, p = 0.032). The complication rates showed no significant difference and were as follows: incidence of enterocolitis was 13.89% in the LHSA group and 20.45% in the LSP group, incidence of constipation was 11.11% after LHSA and 27.27% after LSP, and incidence of soiling was 13.89% after LHSA and 25.00% after LSP. Manometric results of this study show satisfactory outcomes after LHSA. LHSA is an advanced surgical technique to make intestinal anastomosis easy and ensure a good prognosis.

Su1619 - Gender Difference in Patients with Fecal Incontinence: Symptom Severit, Quality of Life, and Hr Anorectal Manometry Results

Su1619 - Gender Difference in Patients with Fecal Incontinence: Symptom Severit, Quality of Life, and Hr Anorectal Manometry Results

Anorectal Pressure Profile in IBD Patients as Compared to Non-IBD Patients With Fecal Incontinence

Introduction: Fecal incontinence is reported in up to 25% of patients with inflammatory bowel disease (IBD). Although diarrhea burden plays a major role in the pathophysiology of fecal incontinence in IBD patients, anorectal sensory and musculoskeletal function has also been shown to be altered in this patient population. There is limited data showing decreased rectal compliance with active IBD. Aim: To compare the anorectal manometry (ARM) pressure profile of IBD patients with active disease presenting with FI versus non-IBD patients with FI. Methods: A retrospective chart review of all IBD patients who were referred for ARM with an indication of FI was done. Among those we identified patients with disease activity found on endoscopy or histology and excluded patients with total proctocolectomy and patients in remission at the time of referral. Those patients (N=6) were matched with controls (N=12) with FI who had no IBD of similar age and BMI in a 2:1 ratio. Comparison of anorectal pressure profiles using 2 tailed t-test was done. Results: Six patients with active IBD (disease location: rectal disease-3, ileal disease-2 and left colon-1) were included and data regarding demographics, disease duration, disease characteristics and data regarding clinical, endoscopic and histological disease activity were obtained (Table 1). Results of ARM are depicted in Table 2. The mean and maximal resting rectal and anal sphincter pressures were higher in IBD patients than non-IBD group and comparable to healthy volunteers. The maximal squeeze anal and rectal pressures were almost two times higher than the non- IBD group, though not statistically significant. The sensory level for first sensation, urge to defecate, discomfort and maximum rectal compliance were lower in those with active IBD.Table: Table. Demographic characteristics on IBD patients with active disease.Table: Table. Comparison of anorectal manometry results of IBD patients with active disease and fecal incontinence and non IBD patients with fecal incontinenceConclusion: Patients with active IBD with FI have a different anorectal pressure profile compared to non IBD patients who suffer from FI. The major difference in anorectal pressure profile appears to be in the anal squeeze pressures, possibly representing a compensatory mechanism; sensory threshold on the other hand were low. Based on these results we suggest that management of FI in IBD should focus on treatment of inflammatory and non-inflammatory diarrhea burden before considering biofeedback and pelvic floor retraining. More studies are needed to assess the anorectal function in patient with IBD.

Analysis of Indications and Results of Anorectal Manometry in Two Tertiary Hospitals in India

The anorectum plays an important role in regulation of defecation and in maintenance of continence [1].

Anorectal manometric parameters are influenced by gender and age in subjects with normal bowel function.

Anorectal manometry provides objective information about anorectal function, but its results depend on the examiner's skill, the type of equipment, and subject characteristics like age or gender. This single institution, prospective study was performed to investigate the effect of gender and age on the results of anorectal manometry. All included subjects completed a questionnaire to assess their bowel function. The survey included 13 validated questions (eight on constipation and five on incontinence) and was used to exclude subjects with pathological constipation or incontinence. Subjects with normal bowel function underwent anorectal manometry to measure anal sphincter length (ASL), maximum resting pressure (MRP), and maximum squeeze pressure (MSP), and the results were compared by gender and age. The mean age of the 154 participants (94 male and 60 female) was 59.1 years. ASL was greater in men (4.23 vs. 3.85 cm, p < 0.001). MRP was not significantly different according to gender (p = 0.93), but MSP was higher in men (190.18 vs. 116.49 mmHg, p < 0.001). ASL did not correlate with age (p = 0.707). MRP was inversely related to age in both men (R (2) = 0.152, p < 0.001) and women (R (2) = 0.282, p < 0.001), and MSP only in women (R (2) = 0.210, p < 0.001). Anorectal manometric parameters are influenced by gender and age. This should be taken into consideration when interpreting manometric readings in a clinical setting.

Randomised controlled trial comparing early home biofeedback physiotherapy with pelvic floor exercises for the treatment of third‐degree tears (EBAPT Trial)

To compare early home biofeedback physiotherapy with pelvic floor exercises (PFEs) for the initial management of women sustaining a primary third-degree tear. Single centre, randomised trial. National Maternity Hospital, Dublin, Ireland. A total of 120 women sustaining a primary third-degree tear. Women were randomised in a one to three ratio: 30 to early postpartum home biofeedback physiotherapy and 90 to PFEs. Differences in anorectal manometry results, Cleveland Clinic continence scores and Rockwood faecal incontinence quality of life scale scores after 3months of postpartum treatment. The mean anal resting pressure was 39±13mmHg in the early biofeedback physiotherapy group and 43±17mmHg in the PFE group. The mean anal squeeze pressure was 64±17mmHg in the biofeedback group and 62±23mmHg in the PFE group. There was no significant difference in anal resting and squeeze pressure values between the groups (P=0.123 and P=0.68, respectively). There were no differences in symptom score and quality of life measurements between the groups. This study demonstrates no added value in using early home biofeedback physiotherapy in the management of women sustaining third-degree tears. Poor compliance may have contributed because women found it difficult to designate time to using biofeedback.

Correlation of Histopathology With Anorectal Manometry Following Stapled Hemorrhoidopexy

PurposeThe removal of smooth muscle during stapled hemorrhoidopexy raises concerns regarding its effects on postoperative anorectal function. The purpose of this study was to evaluate the correlation between the amount of muscle removed and changes in anorectal manometry following stapled hemorrhoidopexy.MethodsPatients with symptomatic II, III, or IV degree hemorrhoids that underwent stapled hemorrhoidopexy between January 2008 and May 2011 were included in this study. Anorectal manometry was performed preoperatively and at three months postoperatively. The resected doughnuts were examined histologically, and the thicknesses of muscle fibers were evaluated.ResultsEighty-five patients (34 males) with a median age of 47 years were included. Muscularis propria fibers were identified in 63 of 85 pathologic specimens (74.1%). The median thickness of the muscle fibers was 1.58 ± 1.21 mm (0 to 4.5 mm). The mean resting pressure decreased by approximately 7 mmHg after operation in the 85 patients (P = 0.019). In patients with muscle incorporation, there was a significant difference in mean resting pressure (P = 0.041). In the analysis of the correlation of the difference in anorectal manometry results ([the result of postsurgical anorectal manometry] - [the result of presurgical anorectal manometry]) to the thickness of muscle fibers, no significant differences were seen. No patients presented with fecal incontinence.ConclusionAlthough the incidence of fecal incontinence is very low, muscle incorporation in the resected doughnuts following stapled hemorrhoidopexy may affect anorectal pressure. Therefore, surgeons should endeavor to minimize internal sphincter injury during stapled hemorrhoidopexy.

The effect of standard compared to enhanced instruction and verbal feedback on anorectal manometry measurements

Guidelines recommend instruction and motivation during anorectal manometry; however, its impact on findings has not been reported. This study assessed the effects of standard versus enhanced instruction and verbal feedback on the results of anorectal manometry. High-resolution manometry was performed by a solid-state catheter with 10 circumferential sensors at 6 mm separation across the anal canal and two rectal sensors. Measurements were acquired first with standard instruction and then with enhanced instruction and verbal feedback. On both occasions, squeeze pressure and duration during three voluntary contractions and intra-rectal pressure and recto-anal pressure gradient (RAPG) during three attempts at simulated defecation were assessed. A total of 70 consecutive patients (54 female; age 25-82 years) referred for investigation of fecal incontinence (n = 31), constipation, and related disorders of defecation (n = 39) were studied. Enhanced instruction and verbal feedback increased maximum squeeze pressure (Δ10 ± 28.5 mmHg; P < 0.0038) and duration of contraction (Δ3 ± 4 s; P < 0.0001). During simulated defecation, it increased intra-rectal pressure (Δ12 ± 14 mmHg; P < 0.003) and RAPG (Δ11 ± 20 mmHg; P < 0.0001). Using standard diagnostic criteria, the intervention changed manometric findings from locally validated 'pathologic' to 'normal' values in 14/31 patients with incontinence and 12/39 with disorders of defecation. Enhanced instruction and verbal feedback significantly improved voluntary anorectal functions and resulted in a clinically relevant change of manometric diagnosis in some patients. Effective explanation of procedures and motivation during manometry is required to ensure consistent results and to provide an accurate representation of patient ability to retain continence and evacuate stool.