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Post-surgical fecal incontinence

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Abstract

The primary endpoint of this work was to understand the pathophysiology of fecal incontinence manifested after rectal and anal surgery. A retrospective cohort study with negative colonoscopy patients was created and 169 postoperative incontinent patients were analyzed (114 women and 55 men: mean age 58.9 ± 6.3): clinical evaluation, endoanal ultrasound and anorectal manometry reports were scanned. The duration of incontinence was very long, with a mean of 21.7 months. The mean number of bowel movements/week was 18.2 ± 7.2. Urge incontinence was present in 82.2% of patients, mixed with passive incontinence in 44 patients. Patients’ Fecal Incontinence Severity Index (FISI) score was 27.0 ± 6.6. Operated patients had significantly lower anal resting pressure (P < 0.01) than controls while patients with colo-anal anastomosis and those who underwent Delorme operation had lowest values (P < 0.01). Maximal tolerated volume and rectal compliance were significantly impaired in operated patients with rectum involvement (colo-anal anastomosis, Delorme, restorative procto-colectomy and STARR). External anal sphincter (EAS) defects were present in 33.1% of all patients and internal anal sphincter (IAS) was damaged in 44.3%: a combined lesion of anal sphincters was detected in 39 patients (23.0%). A positive correlation was found between patients’ FISI score and thickness of both sphincters (EAS: ρs = 73; IAS: ρs = 81). Malfunctioning continence factors may induce fecal incontinence involving each time, in a different way, the volumetric capacity and/or the motility of the rectum, the perception of the fecal bolus and anal sphincter contraction.

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References

  1. O’Donnell LJ, Virjee J, Heaton KW (1988) Pseudo-diarrhoea in the irritable bowel syndrome: patients’ records of stool form reflect transit time while stool frequency does not. Gut 29:A1455

    Google Scholar 

  2. Pucciani F (2013) Faecal soiling: pathophysiology of postdefaecatory incontinence. Colorectal Dis 15:987–992

    Article  CAS  Google Scholar 

  3. Rockwood TH, Church JM, Fleshman JW et al (1999) Patient and surgeon ranking of the severity of symptoms associated with fecal incontinence: the fecal incontinence severity index. Dis Colon Rectum 42:1525–1532

    Article  CAS  Google Scholar 

  4. Engel AF, Kamm MA, Bartram CI, Nicholls RJ (1995) Relationship of symptoms in faecal incontinence to specific sphincter abnormalities. Int J Colorectal Dis 10:152–155

    Article  CAS  Google Scholar 

  5. Pucciani F, Rottoli ML, Bologna A et al (1996) Anterior rectocele and anorectal dysfunction. Int J Colorectal Dis 11:1–9

    Article  CAS  Google Scholar 

  6. Martelli H, Devroede G, Arhan P et al (1978) Some parameters of large bowel motility in normal man. Gastroenterology 75:612–618

    CAS  PubMed  Google Scholar 

  7. Santoro GA, Wieczorek AP, Dietz HP et al (2011) State of the art: an integrated approach to pelvic floor ultrasonography. Ultrasound Obstet Gynecol 37:381–396

    Article  CAS  Google Scholar 

  8. Bellini M, Alduini P, Bassotti G et al (2006) Self-perceived normality in defecation habits. Dig Liver Dis 38:103–108

    CAS  PubMed  Google Scholar 

  9. Sharma A, Yuan L, Marshall RJ et al (2016) Systematic review of the prevalence of faecal incontinence. Br J Surg 103:1589–1597

    Article  CAS  Google Scholar 

  10. Bharucha A (2003) Fecal incontinence. Gastroenterology 124:1672–1685

    Article  Google Scholar 

  11. Johannsson HÖ, Påhlman L, Graf W (2013) Functional and structural abnormalities after Milligan hemorrhoidectomy: a comparison with healthy subjects. Dis Colon Rectum 56:903–908

    Article  Google Scholar 

  12. Hong YK, Choi YJ, Kang JG (2013) Correlation of histopathology with anorectal manometry following stapled hemorrhoidopexy. Ann Coloproctol 29:198–204

    Article  Google Scholar 

  13. Rajasekaran MR, Seo Y, Salehi M et al (2013) Myoarchitectural and functional alteration in the external anal sphincter muscle following experimental surgical myotomy. Gastroenterology 144:S-83 (abstr)

    Article  Google Scholar 

  14. Peker K, Yilmaz I, Demiryilmaz I et al (2014) The effect of lateral internal sphincterotomy on resting anal sphincter pressures. Turk J Med Sci 44:691–695

    Article  Google Scholar 

  15. García-Aguilar J, Belmonte Montes C, Perez JJ et al (1998) Incontinence after lateral internal sphincterotomy: anatomic and functional evaluation. Dis Colon Rectum 41:423–427

    Article  Google Scholar 

  16. Murad-Regadas SM, Fernandes GO, Regadas FS et al (2013) How much of the internal sphincter may be divided during lateral sphincterotomy for chronic anal fissure in women? Morphologic and functional evaluation after sphincterotomy. Dis Colon Rectum 56:645–651

    Article  Google Scholar 

  17. Bove A, Balzano A, Perrotti P et al (2004) Different anal pressure profiles in patients with anal fissure. Tech Coloproctol 8:151–157

    Article  CAS  Google Scholar 

  18. Malik AI, Nelson RL (2008) Surgical management of anal fistulae: a systematic review. Colorectal Dis 10:420–430

    Article  CAS  Google Scholar 

  19. Ratto C, Litta F, Donisi L, Parello A (2015) Fistulotomy or fistulectomy and primary sphincteroplasty for anal fistula (FIPS): a systematic review. Tech Coloproctol 19:391–400

    Article  CAS  Google Scholar 

  20. Pary PB, Enker WE, Cohen AM (1994) Long-term functional results of colorectal anastomosis for rectal cancer. Am J Surg 167:90–94

    Article  Google Scholar 

  21. Kocaay AF, Oztuna D, Su FA et al (2017) Effects of hysterectomy on pelvic floor disorders: a longitudinal study. Dis Colon Rectum 60:303–310

    PubMed  Google Scholar 

  22. Karasick S, Spettell CM (1997) The role of parity and hysterectomy on the development of pelvic floor abnormalities revealed by defecography. AJR Am J Roentgenol 169:1555–1558

    Article  CAS  Google Scholar 

  23. Pucciani F, Boni D, Perna F et al (2005) Descending perineum syndrome: are abdominal hysterectomy and bowel habits linked? Dis Colon Rectum 48:2094–2099

    Article  Google Scholar 

  24. Ho YH, Goh HS (1995) The neurophysiological significance of perineal descent. Int J Colorectal Dis 10:107–111

    Article  CAS  Google Scholar 

  25. Emile SH, Elbanna H, Youssef M et al (2017) Laparoscopic ventral mesh rectopexy vs Delorme’s operation in management of complete rectal prolapse: a prospective randomized study. Colorectal Dis 19:50–57

    Article  CAS  Google Scholar 

  26. Cavazzoni E, Rosati E, Zavagno V et al (2015) Simultaneous Delorme’s procedure and inter-sphincteric prosthetic implant for the treatment of rectal prolapse and faecal incontinence: preliminary experience and literature review. Int J Surg 14:45–48

    Article  Google Scholar 

  27. Ramage L, Qiu S, Georgiou P et al (2016) Functional outcomes following ileal pouch-anal anastomosis (IPAA) in older patients: a systematic review. Int J Colorectal Dis 31:481-a92

    Article  Google Scholar 

  28. Boccasanta P, Venturi M, Roviaro G (2011) What is the benefit of a new stapler device in the surgical treatment of obstructed defecation? Three year outcomes from a randomized controlled trial. Dis Colon Rectum 54:77–84

    Article  Google Scholar 

  29. Meurette G, Wong M, Frampas E (2011) Anatomical and functional results after stapled transanal rectal resection (STARR) for obstructed defecation syndrome. Colorectal Dis 13:e6–e11

    Article  CAS  Google Scholar 

  30. Jayne DG, Schwandner O, Stuto A (2009) Stapled transanal rectal resection for obstructed defecation syndrome: one-year results of the European STARR registry. Dis Colon Rectum 52:1205–1212

    Article  CAS  Google Scholar 

Download references

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  1. Department of Surgery and Translational Medicine, University of Florence, Largo Brambilla 3, 50134, Florence, Italy

    Filippo Pucciani

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  1. Filippo Pucciani
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Correspondence to Filippo Pucciani.

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Pucciani, F. Post-surgical fecal incontinence. Updates Surg 70, 477–484 (2018). https://doi.org/10.1007/s13304-017-0508-y

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