Tibial Nerve Research Articles

The effectiveness of neurodynamic techniques in patients with diabetic peripheral neuropathy: Study protocol for a randomized sham-controlled trial

Abstract Background: Diabetic peripheral neuropathy (DPN) is one of the most common complications of diabetes mellitus (DM). DPN is the primary risk factor for diabetic foot ulcers that can cause amputation. Although several observational studies have investigated the morphological and biomechanical characteristics of peripheral nerves in DPN, interventional studies regarding the effectiveness of neurodynamic techniques (NDT) in DPN patients are confined to a handful. The effects of NDT on neuropathy severity, nerve conduction parameters, quality of life (QoL), and mechanosensitivity have not been explored yet in this population. Materials and Methods: Forty type 2 DPN (T2DPN) patients, diagnosed based on an electrodiagnosis study, will be recruited into two groups. The experimental group will receive the tibial nerve’s real proximal and distal slider techniques in addition to DPN standard treatment as a basic treatment, and the control group will receive the tibial nerve’s sham proximal and distal slider techniques along with the basic treatment for eight sessions twice a week. Baseline and post-intervention assessments will be based on the Michigan diabetic neuropathy score (MDNS) (primary outcome), tibial nerve conduction parameters, neuropathy-specific quality of life (Neuro QoL) questionnaire, and straight leg raising range of motion (SLR ROM) (secondary outcomes). Results: This study is expected to last approximately seven months, depending on recruitment. The results of the study will be published in a peer-reviewed journal. Conclusions: The present study will evaluate the efficacy of NDT on the primary and secondary outcome measurements in DPN patients.

Ultrasound evaluation and grading of neuromuscular disease in lower extremities among diabetic patients.

To explore the clinical utility of ultrasound in evaluating and grading neuromuscular diseases in the lower extremities of patients with diabetes mellitus. A total of 126 inpatients from the Department of Diabetes at Zhangzhou Affiliated Hospital of Fujian Medical University, China, were recruited from June 2020 to December 2022. The cohort included 69 patients with type 2 diabetes mellitus (T2DM) and diabetic peripheral neuropathy (DPN group) and 57 patients with T2DM but without DPN (non-DPN group). Additionally, 80 healthy controls were included. High-frequency ultrasound was used to scan the common peroneal, sural, and tibial nerves, measuring their transverse (D1) and anteroposterior (D2) diameters, and calculating the cross-sectional area (CSA). Changes in the internal echo of the extensor digitorum brevis (EDB) muscle, including maximum thickness and CSA, were also recorded. The DPN group was further subdivided based on disease duration to assess ultrasonic changes over time and the statistical significance of these variations. Ultrasonic changes such as uneven internal echo reduction, ill-defined epineurial boundaries, and obscured cribriform structures were most prevalent in the DPN group. Significant differences in ultrasound parameters (D1, D2, CSA) were observed among the groups (all P<0.05), with the most pronounced changes in the DPN group. In patients with a disease duration of over 15 years, a significant increase in CSA of lower extremity nerves and a decrease in CSA of the EDB were noted compared to those in the 5-10 years subgroup (19.89±0.98 vs 19.00±0.94; 5.25±0.74 vs 5.93±0.94; all P<0.05). High-frequency ultrasound provides a valuable imaging basis for diagnosing and monitoring DPN, demonstrating significant changes in nerve and muscle parameters among diabetic patients.

Weight-bearing Ultrasound to Diagnose Talar Dislocation Causing Tarsal Tunnel Syndrome.

The neuropathic compression of the tibial nerve and/or its branches on the medial side of the ankle is called tarsal tunnel syndrome (TTS). Patients with TTS presents pain, paresthesia, hypoesthesia, hyperesthesia, muscle cramps or numbness which affects the sole of the foot, the heel, or both. The clinical diagnosis is challenging because of the fairly non-specific and several symptomatology. We demonstrate a case of TTS caused by medial dislocation of the talar bone on the calcaneus bone impacting the tibial nerve diagnosed only by ultrasound with the patient in the standing position.

Chapter 10 - Sciatic and tibial neuropathies

The sciatic nerve is the body's largest peripheral nerve. Along with their two terminal divisions (tibial and fibular), their anatomic location makes them particularly vulnerable to trauma and iatrogenic injuries. A thorough understanding of the functional anatomy is required to adequately localize lesions in this lengthy neural pathway. Proximal disorders of the nerve can be challenging to precisely localize among a range of possibilities including lumbosacral pathology, radiculopathy, or piriformis syndrome. A correct diagnosis is based upon a thorough history and physical examination, which will then appropriately direct adjunctive investigations such as imaging and electrodiagnostic testing. Disorders of the sciatic nerve and its terminal branches are disabling for patients, and expert assessment by rehabilitation professionals is important in limiting their impact. Applying techniques established in the upper extremity, surgical reconstruction of lower extremity nerve dysfunction is rapidly improving and evolving. These new techniques, such as nerve transfers, require electrodiagnostic assessment of both the injured nerve(s) as well as healthy, potential donor nerves as part of a complete neurophysiological examination.

Evaluation of Brain Stem Function in Diabetics with and Without Distal Symmetrical Polyneuropathy Using the Blink Reflex

Background: Diabetic peripheral neuropathy (DPN) is the commonest complication of T2DM. Neuropathy is a descriptor for a spectrum of clinical and subclinical symptoms with varying anatomical distributions, clinical histories, and perhaps underlying pathogenetic mechanisms. The distal Symmetrical sensory polyneuropathy is chronic, symmetrical, length-dependent sensorimotor. Studies of the blink reflex have shown potential as a method of assessing brainstem activity. Objective: The primary purpose of this research was to assess the function of the blink reflex in the early detection of cranial nerves and brain stem dysfunction in diabetes patients with and without polyneuropathy. We also aimed to see whether there were differences in blink reflex abnormalities between diabetes individuals with and without polyneuropathy. Patients and Methods: The study included a group of sixty-60 diabetic patients. Clinician and electrophysiologist evaluations were used to determine the severity of neuropathy. Patients with diabetes were separated into two groups: those with and without neuropathy. Results: A statistically significant difference between the two groups was for C.R.2 latency, and I.R.2 latency with a P-value &lt;0.001. Except for blink reflex’s R1 latency (P-value &gt;0.2), all other Blink reflex parameters were statistically different between patients who experience diabetic neuropathy and those who didn’t. Regarding HbA1c, a significant positive association with IR2 latency and C.R.2 latency was noted (Pvalue &lt;0.001) and also, a statistically significant negative association was found with I.R.2 duration and C.R.2 duration (P-value &lt;0.001). Amplitudes of sural, tibial and peroneal nerves were negatively associated with Blink reflex Latencies and positively associated with blink reflex duration. Conclusion: In conclusion, blink-reflex parameters (including ipsi-lateral R.2 latency, contra-lateral R.2 latency) are significantly associated with HBA1C level and degree of peripheral diabetic neuropathy. Received Sept. 2022 Accepted Nov. 2023 Published Jan. 2024

Harnessing historical data to derive reference limits – A comparison of e-norms to traditionally derived reference limits

ObjectiveNerve conduction studies (NCS) require valid reference limits for meaningful interpretation. We aimed to further develop the extrapolated norms (e-norms) method for obtaining NCS reference limits from historical laboratory datasets for children and adults, and to validate it against traditionally derived reference limits. MethodsWe compared reference limits obtained by applying a further developed e-norms with reference limits from healthy controls for the age strata’s 9–18, 20–44 and 45–60 years old. The control data consisted of 65 healthy children and 578 healthy adults, matched with 1294 and 5628 patients respectively. Five commonly investigated nerves were chosen: The tibial and peroneal motor nerves (amplitudes, conduction velocities, F-waves), and the sural, superficial peroneal and medial plantar sensory nerves (amplitudes, conduction velocities). The datasets were matched by hospital to ensure identical equipment and protocols. The e-norms method was adapted, and reference limit calculation using both ±2 SD (original method) and ±2.5 SD (to compensate for predicted underestimation of population SD by the e-norms method) was compared to control data using ±2 SD. Percentage agreement between e-norms and the traditional method was calculated. ResultsOn average, the e-norms method (mean ±2 SD) produced slightly stricter reference limits compared to the traditional method. Increasing the e-norms range to mean ±2.5 SD improved the results in children while slightly overcorrecting in the adult group. The average agreement between the two methods was 95 % (±2 SD) and 96 % (±2.5 SD). ConclusionsThe e-norms method yielded slightly stricter reference limits overall than ones obtained through traditional methods; However, much of the difference can be attributed to a few outlying plots where the raters found it difficult to apply e-norms correctly.The two methods disagreed on classification of 4–5% of cases. Our e-norms software is suited to analyze large amounts of raw NCS data; it should further reduce bias and facilitate more accurate ratings. SignificanceWith small adaptations, the e-norms method adequately replicates traditionally derived reference limits, and is a viable method to produce reference limits from historical datasets.

The Value of Muscle Thickness of Lower Limbs in Detection of Diabetic Peripheral Neuropathy

&#x0D; Background: Neuropathy stands out as the highest-prevalence diabetes-related complication, impacting no less than 50% of individuals with diabetes throughout their lifespan. As The most common reason for disability due to walking difficulties, foot ulcerations, and limb loss, DPN is worthy of study, and early diagnosis of DPN signs is required.&#x0D; Objectives: This study aims to aid in the identification of diabetic peripheral neuropathy (DPN) by determining the muscle thickness of the lower extremities in patients with DPN.&#x0D; Patients and Methods: The study included 24 subjects with diabetic peripheral neuropathy (DPN) and 25 individuals as a control group, subdivided into 8 diabetic patients without DPN and 17 healthy individuals. Both control and DPN subjects underwent bilateral peroneal and tibial motor nerve conduction studies (NCS) and high-resolution muscle ultrasounds to measure muscle thickness. Abductor hallucis muscle (AH), extensor digitorum brevis muscle (EDB), extensor hallucis longus muscle (EHL), tibialis anterior muscle (TA), and rectus femoris muscle (RF) were evaluated on both sides using ultrasound.&#x0D; Results: Comparing the tested muscles to the control group, the study revealed a statistically significant decrease in the thickness of many of the muscles being tested when compared to the control group.&#x0D; Conclusions: These findings point to the possibility that quantitative muscle ultrasound could be beneficial in identifying muscle changes associated with DPN. It is necessary to conduct additional studies to verify the results in larger samples of diabetic patients.&#x0D; Keywords: Neuromuscular Ultrasound, Muscle Thickness, Diabetic Peripheral Neuropathy

Evolving types of pudendal neuromodulation for lower urinary tract dysfunction.

Sacral neuromodulation and posterior tibial nerve stimulation for lower urinary tract dysfunction (LUTD) and overactive bladder yield good and reliable results. However, neuromodulation research is continuously evolving because there is still need for more patient-friendly treatment options in the therapeutic management of LUTD. Pudendal neuromodulation (PNM) has been emerging as a promising alternative treatment option for the last few decades. The aim of this study is to review the current state of the art of PNM. A wide literature search was conducted in the field of PNM using Medline through the PubMed database and Elsevier using the Scopus database; a critical review of the results was then carried out. PNM has been studied in its various possible aspects: percutaneous PNM, transrectal/transvaginal PNM, and both percutaneous and transcutaneous dorsal genital nerve stimulation. Each technique was found to result in promising improvements in different clinical outcomes, with some trials reporting even better results than sacral neuromodulation. As a result of a comparison between the various PNM techniques with both sacral neuromodulation and posterior tibial nerve stimulation, we think that PNM should be seen as seriously promising, and we believe it will expand the treatment options for overactive bladder. Even though several studies accordingly showed PNM to be safe and effective, a systematic review and meta-analysis were not feasible. PNM in its various techniques is a promising treatment for LUTD. Nevertheless, further research is needed to include it in treatment algorithms.

Proximity of Percutaneous Tibial Nerve Stimulation Needle Insertion to Surrounding Anatomic Structures: A Cadaveric Study

(Abstracted from Am J Obstet Gynecol 2023;229:430.e1–430.e6) Each year, spending on treatment of overactive bladder and urinary urgency sans incontinence uses at least $65.9 billion. Although many treatments for such conditions exist, the third line of medication is percutaneous tibial nerve stimulation (PTNS) for patients who wish to avoid onabotulinum toxin treatment and decline implanted devices.

Pembrolizumab-associated Neuronopathy with Improved Lower Limb Somatosensory Evoked Potential After Intravenous Methylprednisolone Treatment: A Case Report.

Cases of neuronopathy associated with immune checkpoint inhibitors (ICIs) have rarely been reported. We herein report a case of ICI-associated neuronopathy. A 54-year-old man underwent chemotherapy for right maxillary sinus cancer. Two months after pembrolizumab treatment, diarrhea, worsening of abnormal sensations, and severe ataxia of the lower limbs were observed. Somatosensory evoked potentials (SEPs) with tibial nerve stimulation showed disappearance of the N21 waveform. A colonic biopsy suggested ICI-associated colitis. Based on these findings, the patient was diagnosed with ICI-associated neuronopathy. Clinical symptoms and SEP findings improved markedly after two courses of intravenous methylprednisolone.

Midterm Outcomes after Operative Management of Hawkins Type III Talar Neck Fractures.

This study aims to report the midterm outcomes after surgical treatment of Hawkins Classification III Talar neck fractures. From March 2010 to April 2022, among a total of 155 patients who visited our hospital with talus fractures, 31 patients underwent surgical treatment for Hawkins classification III talar neck fractures. The inclusion criteria comprised patients with a symptom duration of over 1 year who were available for outpatient follow-up and underwent magnetic resonance imaging (MRI) follow-up 2 months after surgery. Exclusion criteria included patients without preoperative ankle periarticular arthritis, and a total of 27 patients were enrolled. Traffic accidents and falls accounted for 86% of 23 cases, open fractures were 8 cases, and the mean follow-up period was 34.10 months (range, 12-80 months). Clinical outcomes were measured by American Orthopaedic Foot and Ankle Society (AOFAS) score and Foot function index (FFI), and radiological results were obtained using simple radiographs before and after surgery and MRI at 2 months postoperatively to confirm bone union and complications. Complete bone union was achieved in all cases, and the mean duration of union was 4.9 months (range, 4-6 months) and there were no nonunion and varus malunion. At the final follow-up, the mean AOFAS score was 80.18 points (range, 36-90 points) and the mean FFI score was 31.43 points (range, 10-68 points), showing relatively good clinical outcomes. There were 15 cases of avascular necrosis, 6 cases of traumatic arthritis of the ankle joint, 6 cases of irritation of the posterior tibial nerve, and 4 cases of wound problems. Hawkins classification III talar neck fractures are mostly caused by high-energy injuries and have a relatively poor prognosis due to the high incidence of complications such as avascular necrosis or posttraumatic arthritis. However, if correct anatomical reduction and rigid internal fixation are performed within a short time after the injury, good results can be expected.

Effect of Transcutaneous Tibial Nerve Stimulation on the Overactive Bladder in Women with Type 2 Diabetes

Background and Aims Diabetes mellitus is one of the most prevalent metabolic conditions in the world. One of its consequences is overactive bladder (OAB), which is a syndrome whose symptoms appear during the urine storage phase in the form of increased urinary frequency or urinary urgency. The prevalence of this disorder is estimated to be 22.5-24.2 % in people with type 2 diabetes (T2D). Recently, a useful technique for the treatment of OAB, named transcutaneous tibial nerve stimulation (TTNS), has been introduced. This study aims to investigate the effect of TTNS in women with T2D and OAB. Methods This randomized, double-blind clinical trial was conducted on 40 women with T2D and OAB symptoms, who were divided into two control and intervention groups. The control group performed pelvic floor muscle (PFM) training daily for one month, while the intervention group received 12 sessions of TTNS combined with PFM training. Before and after the intervention, the lower urinary tract symptoms were recorded using the Persian version of the International Consultation on Incontinence Modular Questionnaire for Female Lower Urinary Tract Symptoms (ICIQ-FLUTS). Independent t-test, paired t-test, Wilcoxon test, Mann-Whitney U test, and chi-square test were performed for data analysis using SPSS software, version 24. Results There was no significant difference between the two groups in the ICIQ-FLUTS score, incontinence quality of life, or PFM strength, and endurance (P&gt;0.05). However, their scores were significantly different after treatment in each group compared to the pre-treatment phase (P≤0.05). Conclusion The combination of TTNS and PFM training has no advantage over PFM training alone in managing OAB symptoms and improving PFM strength and quality of life in women with T2D.

Objective Evaluation of Local Muscle Fatigue in Cerebral Palsy Using A Gait Corrector

The participants were seven individuals (age range 7–36 years) whose walking ability ranged from independent to requiring assistance with a cane, walker, etc. The protocol consisted of resting for at least five minutes before starting to walk, wearing a Gait Corrector device, and walking with light and heavy loads based on the participant's rating of perceived exertion (RPE), followed by resting for 10 minutes before the end of the protocol.Near-infrared spectroscopy (NIRS) electrodes were attached bilaterally to the tibialis anterior and lateral gastrocnemius muscles. NIRS was used to measure blood oxygenation dynamics in local muscles from rest before walking to 10 minutes after walking, and evoked electromyography was used to measure the nerve conduction velocity of the peripheral nerves before and during early and late walking.The tone state of the lateral gastrocnemius muscle was measured three times using an evoked potential-testing device: before walking, immediately after heavy-load walking, and 10 minutes after walking. A recording electrode was attached to the abductor digitorum medialis muscle and a reference electrode was attached to the base of the toe. The M and F waves were recorded using tibial nerve stimulation. The average F/M ratio was used as a parameter of the F-wave.Regarding the change in muscle tone, four of the seven patients exhibited no change or a lower mean F/M ratio after walking than before walking, whereas three patients who exhibited resistance to other dorsiflexion movements of the ankle joint had higher values. Blood oxygenation dynamics revealed a greater disparity between oxyhemoglobin and deoxyhemoglobin concentrations after walking in all participants, suggesting local muscle fatigue, the degree of which showed no improvement even after 10 minutes of rest.

Dellon Triple Decompression under WALANT

The Wide-Awake Local Anesthesia No Tourniquet (WALANT) Approach to Dellon Triple decompression involves the use of local anesthetic with epinephrine and no tourniquet. This study shows that WALANT is a safe and effective procedure and can be performed in an outpatient setting for the decompression of the common peroneal nerve in the knee, tibial nerve in the ankle and deep peroneal nerve in the dorsum of the foot in diabetic patients with superimposed nerve compressions to diabetic neuropathy. WALANT technique demonstrated to be a safe procedure to surgically treat diabetic patients with superimposed compressive neuropathy to diabetic neuropathy in the lower limbs and had no complications.

Peripheral Nerve Stimulation With High-Frequency Electromagnetic Coupling at the Sural and Posterior Tibial Nerves for the Treatment of Complex Regional Pain Syndrome in Lower Extremities: Case Report

BACKGROUND: Complex regional pain syndrome (CRPS) type 1 is a debilitating condition that is notoriously difficult to treat due to its various manifestations. Peripheral nerve stimulation (PNS) is generally recommended when a patient’s symptoms are refractory to conservative measures, as CRPS often is. We present one case of CRPS with intractable lower extremity pain managed effectively with PNS. CASE REPORT: A 32-year-old man developed CRPS after a work-related accident that resulted in multiple injuries, including a crushed pelvis, injured left lower extremity, and a fractured face and skull. After pelvic and hip reconstruction, the patient was left with numbness, tingling, and pain in the left foot affecting functional activities and sleep. Previous therapies, including nerve blocks, physical therapy, narcotics, opioids, anticonvulsants, antidepressants, and nonsteroidal anti-inflammatory drugs, did not alleviate symptoms. The placement of a PNS device, however, led to significant improvement. RESULTS: Pain scores at baseline compared to 12-month follow-up decreased from 6/10 to 2/10 at rest and from 8/10 to 4/10 with activity. Average hours of sleep per night increased from 4 to 8 hours (an improvement of 100%). Antidepressants have been discontinued and opioids reduced to an as-needed basis (once every few days). The patient reports decreased sensitivity to cold, reduced swelling, and improved color changes in the foot. In addition, the patient has been able to increase activity, such as walking, standing, and wearing closed-toed shoes, from 20 minutes to now 4 hours at a time with pain levels maintained at a 4/10. CONCLUSIONS: Subthreshold PNS utilizing high-frequency electromagnetic coupling at the posterior tibial and sural nerves successfully relieved the patient’s chronic, debilitating pain in the lower extremity as a result of CRPS. KEY WORDS: Peripheral nerve stimulation, chronic pain, posterior tibial, sural, CRPS, lower extremity, foot

Neuroanatomy of lumbosacral and pudendal plexus in pigeon of Bangladesh

The present study aims to reveal the neuroanatomy of the lumbosacral and pudendal plexus in pigeons of Bangladesh. Six adult male domesticated pigeons were used in this study. The body cavities of the pigeons were opened after the administration of the anesthetics. The nerve roots of the plexus were dissected separately and photographed. We found that the lumbosacral plexus consisted of the lumbar plexus and the sacral plexus. The lumbar plexus was formed by the union of the ventral branches of the first, second, and third lumbar (L1-L3) spinal nerves. The lumbar plexus was branched into cutaneous femoris nerve, coxalis cranialis nerve, femoralis nerve, saphenous nerve, and obturatorius nerve. The sacral plexus was formed by the union of the ventral branches of the fourth lumbar and first, second, third, and fourth sacro-coccygeal spinal nerves. The sacral plexus gives off a large sciatic nerve and innervated as tibial and fibular nerve into musculature of the hind limb of the pigeon. The pudendal plexus was organized from the fourth, fifth, sixth and seventh sacro-coccygeal spinal nerves and were innervated into the tail region of the domesticated pigeons. This study was the first investigation of lumbosacral and pudendal plexus in domesticated pigeons and the results may serve as a basis for further investigation in other species. Bangladesh Journal of Animal Science 52 (4): 98-104

Neuroanatomy of lumbosacral and pudendal plexus in pigeon of Bangladesh

The present study aims to reveal the neuroanatomy of the lumbosacral and pudendal plexus in pigeons of Bangladesh. Six adult male domesticated pigeons were used in this study. The body cavities of the pigeons were opened after the administration of the anesthetics. The nerve roots of the plexus were dissected separately and photographed. We found that the lumbosacral plexus consisted of the lumbar plexus and the sacral plexus. The lumbar plexus was formed by the union of the ventral branches of the first, second, and third lumbar (L1-L3) spinal nerves. The lumbar plexus was branched into cutaneous femoris nerve, coxalis cranialis nerve, femoralis nerve, saphenous nerve, and obturatorius nerve. The sacral plexus was formed by the union of the ventral branches of the fourth lumbar and first, second, third, and fourth sacro-coccygeal spinal nerves. The sacral plexus gives off a large sciatic nerve and innervated as tibial and fibular nerve into musculature of the hind limb of the pigeon. The pudendal plexus was organized from the fourth, fifth, sixth and seventh sacro-coccygeal spinal nerves and were innervated into the tail region of the domesticated pigeons. This study was the first investigation of lumbosacral and pudendal plexus in domesticated pigeons and the results may serve as a basis for further investigation in other species. Bangladesh Journal of Animal Science 52 (4): 98-104

Effects of posterior tibial nerve stimulation (PTNS) on lower urinary tract dysfunction: An umbrella review.

Lower urinary tract dysfunction (LUTD) is a common, troublesome condition that often negatively affects patients' quality of life. Current literature has long been interested in how posterior tibial nerve stimulation (PTNS) can affect this condition. To extensively and systematically explore how PTNS affects LUTD based on the most recent systematic reviews. A systematic search was conducted in PubMed, Scopus, Web of Science, and Embase according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. All the systematic reviews, with or without meta-analysis that assessed the effects of PTNS on LUTD were retrieved. The quality of the included studies was assessed using the Joanna Briggs Institute tool, and analysis was conducted using the Comprehensive Meta-Analysis version 3 tool. From a total of 3077 citations, 20 systematic reviews entered this study, and 13 of them included meta-analysis. The population of studies varied vastly, for instance, some studies included only children or women while other focused on a specific pathology like multiple sclerosis-induced neurogenic LUTD. The majority of included studies reported an overall improvement in LUTD following percutaneousPTNS, although admitting that these results were derived from moderate to low-quality evidence. The findings of this thorough umbrella review showed that the positive benefits of PTNS in treating LUTD are currently supported by low-quality evidence, and it is crucial to interpret them with great care.

The occurrence, precaution and treatment strategies of postoperative fecal incontinence in rectal and anal diseases

In the surgical treatment of hemorrhoids, rectal prolapse, rectal cancer, anal fissures, or anal fistulas, inadvertent damage to the nerves or muscles responsible for bowel control may potentially lead to varying degrees of fecal incontinence (FI). Surgeons need to conduct preoperative assessments based on the patient's individual condition to select an appropriate surgical plan, aiming to minimize the incidence of postoperative FI and improve the patient's postoperative quality of life as much as possible while effectively treating the disease. Additionally, the proficiency of the surgeon's skills, appropriate preoperative dietary adjustments for the patient, regular bowel habits, and exercises targeting the pelvic floor muscles all contribute to reducing the incidence of postoperative FI in patients. For patients who have already developed FI after surgery, on the basis of suitable diet, regular bowel habits, and medication, clinical practitioners can adopt such methods as biofeedback, pelvic floor muscle exercise, sacral nerve stimulation, percutaneous tibial nerve stimulation, acupuncture, injectable bulking agents, anal or vaginal inserts, transanal irrigation, surgical interventions, psychological support, etc., to individualized treatment for patients' conditions. This article, combining the literature, summarizes the current status of common diseases that may lead to postoperative FI. It elaborates on strategies for the prevention and treatment of postoperative FI, aiming to serve as a reference for peers in the field.

Surgical treatment of fecal incontinence

This article describes the surgical treatment of fecal incontinence. There are many surgical methods for fecal incontinence, and each treatment has its own advantages and disadvantages and indications. The appropriate surgical procedure should be selected according to the patient's history, anatomical structure and severity of incontinence. Injectable bulking agents is suitable for passive fecal incontinence. Sphincteroplasty is suitable for patients with sphincter injury caused by vaginal delivery or surgical trauma. Sacral nerve stimulation and posterior tibial nerve stimulation are relatively conservative methods. Gracilomyoplasty, artificial anal sphincter or magnetic anal sphincter can be used in the treatment of refractory fecal incontinence, but with many complications. Colostomy is the ideal choice for patients who have failed to respond to conservative treatment and cannot undergo these procedures.