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Updates in treating fecal incontinence in women. Curr Opin Obstet Gynecol 2020; 32:461-467. [PMID: 32925257 DOI: 10.1097/gco.0000000000000660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Fecal incontinence is a chronic condition that can significantly affect a woman's quality of life. The pathogenesis of fecal incontinence is multifaceted and management ranges from supportive care, medical therapy to more invasive surgical procedures. This review will discuss the recent advancements in treating fecal incontinence. RECENT FINDINGS The pelvic floor disorder consortium has created a consensus document with recommendations on pelvic floor symptom measurement tools, patient-reported instruments, and questionnaires that should be used when evaluating fecal incontinence. There is new robust data reinforcing the importance of conservative management prior to proceeding with more invasive treatment. Lastly, several novel therapies that were developed in the past decade now have longer term data on safety and efficacy. SUMMARY Management of fecal incontinence is challenging, as no one therapy has been proven to be predominately effective. We should continue to first optimize patients with conservative therapy followed by induction of more advanced therapies. There needs to be continued efforts to develop and evaluate effective treatment guidelines and therapies for fecal incontinence.
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Vergara-Fernandez O, Arciniega-Hernández JA, Trejo-Avila M. Long-term outcomes of radiofrequency treatment for fecal incontinence: are the results maintainable? Int J Colorectal Dis 2020; 35:173-176. [PMID: 31802189 DOI: 10.1007/s00384-019-03458-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/12/2019] [Indexed: 02/04/2023]
Abstract
PURPOSE Temperature-controlled radiofrequency (RF) energy delivery to the sphincter complex has been proposed as an option for those patients not susceptible to a major surgical procedure for fecal incontinence (FI). The aim of the study was to evaluate the long-term (15 years) functional outcomes obtained after RF procedure for FI. METHODS This was a retrospective analysis of our prospectively collected database of patients that underwent RF procedure for FI. Primary outcomes measured were the Cleveland Clinic Florida Fecal Incontinence scale (CCF-FI), Fecal Incontinence-related Quality of Life Score (FIQLS), the 36-Item Short Form survey (SF-36), endoanal ultrasound, and anorectal manometry. Evaluations were compared at baseline and at 15 years of follow-up. RESULTS Ten patients were followed up 15 years after RF procedure. There was no significant improvement in the CCF-FI score (13.8 vs. 12.4, p = 0.24). No significant changes in the FIQLS were observed including lifestyle (2.39 vs. 2.13, p = 0.23), coping (1.91 vs. 1.92, p = 0.96), and embarrassment (1.66 vs. 1.86; p = 0.43). However, significant worsening was found in the depression category (2.47 vs. 1.60, p = 0.001). The SF-36 showed significant worsening in the mental (36.7 vs. 25.8, p < 0.001), physical (53.1 vs. 41.4, p = 0.01), and social functions (50.9 vs. 31.25, p = 0.001). Anorectal manometry and endoanal ultrasound showed no significant changes. No complications were found in the long-term follow-up. CONCLUSIONS Radiofrequency procedure for fecal incontinence did not maintain its efficacy during long-term follow-up.
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Affiliation(s)
- Omar Vergara-Fernandez
- Department of Colorectal Surgery, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga 15.14000 Tlalpan, Mexico City, Mexico
| | - Jose Armando Arciniega-Hernández
- Department of Colorectal Surgery, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga 15.14000 Tlalpan, Mexico City, Mexico
| | - Mario Trejo-Avila
- Department of Colorectal Surgery, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga 15.14000 Tlalpan, Mexico City, Mexico.
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Mandolfino F, Fornaro R, Stabilini C, Casaccia M, Testa T, Frascio M. SECCA procedure for anal incontinence and antibiotic treatment: a case report of anal abscess. BMC Surg 2018; 18:53. [PMID: 30086744 PMCID: PMC6081846 DOI: 10.1186/s12893-018-0389-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 08/01/2018] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Fecal Incontinence (FI) can seriously affect quality of life. The treatment of fecal incontinence starts conservatively but in case of failure, different surgical approaches may be proposed to the patient. Recently several not invasive approaches have been developed. One of these is the radiofrequency (RF) energy application to the internal anal sphincter. CASE PRESENTATION We report a rare case of an anal abscess related to a SECCA procedure in a 66-year-old woman affected by gas and FI for twenty years. CONCLUSIONS The complications post-SECCA procedure reported in literature are generally not serious and often self-limited, such as bleeding or anal pain. This is a case of an anal abscess. We suggest that this finding could consolidate the importance of administering antibiotic therapy to patients and to run a full course of at least 6 days rather than a short-term (24 h) therapy, with the aim to minimize the incidence of this complication.
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Affiliation(s)
- Francesca Mandolfino
- Dipartimento di Scienze Chirurgiche e Diagnostiche Integrate (DISC), Università degli Studi di Genova, Largo R. Benzi, 8, Genoa, Italy
| | - Rosario Fornaro
- Dipartimento di Scienze Chirurgiche e Diagnostiche Integrate (DISC), Università degli Studi di Genova, Largo R. Benzi, 8, Genoa, Italy
| | - Cesare Stabilini
- Dipartimento di Scienze Chirurgiche e Diagnostiche Integrate (DISC), Università degli Studi di Genova, Largo R. Benzi, 8, Genoa, Italy
| | - Marco Casaccia
- Dipartimento di Scienze Chirurgiche e Diagnostiche Integrate (DISC), Università degli Studi di Genova, Largo R. Benzi, 8, Genoa, Italy
| | - Tommaso Testa
- IRCCS Azienda Ospedaliera Universitaria Policlinico San Martino–IST, Largo R. Benzi, 8, Genoa, Italy
| | - Marco Frascio
- Dipartimento di Scienze Chirurgiche e Diagnostiche Integrate (DISC), Università degli Studi di Genova, Largo R. Benzi, 8, Genoa, Italy
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Abstract
Fecal incontinence is a highly prevalent and distressing condition that has a negative impact on quality of life. The etiology is often multifactorial, and the evaluation and treatment of this condition can be hindered by a lack of understanding of the mechanisms and currently available treatment options. This article reviews the evidence-based update for the management of fecal incontinence.
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Affiliation(s)
- Isuzu Meyer
- Division of Urogynecology and Pelvic Reconstructive Surgery, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, 1700 6th Avenue South, Suite 10382, Birmingham, AL 35233, USA.
| | - Holly E Richter
- Division of Urogynecology and Pelvic Reconstructive Surgery, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, 1700 6th Avenue South, Suite 10382, Birmingham, AL 35233, USA
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Kalra GDS, Sharma AK, Shende KS. Gracilis muscle transposition as a workhorse flap for anal incontinence: Quality of life and functional outcome in adults. Indian J Plast Surg 2016; 49:350-356. [PMID: 28216815 PMCID: PMC5288910 DOI: 10.4103/0970-0358.197245] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND/PURPOSE Anal incontinence is one of the most psychologically and socially debilitating conditions in an otherwise healthy individual. It can lead to social isolation, loss of self-esteem, self-confidence and depression. This study is devoted to the problem of anal incontinence in the adult patients. The aim of our study is to analyse the results of gracilis muscle transposition for anal incontinence and improvement in quality of life (QOL) of patients. MATERIALS AND METHODS This was a retrospective study. A total of 18 patients with complaint of anal incontinence were enrolled in this study. All patients were treated with gracilis muscle transposition. RESULTS All patients are continent, and there is an improvement in their QOL. CONCLUSION Gracilis muscle transposition is a good option for patients of anal incontinence who are not treated by non-surgical means.
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Affiliation(s)
| | - Amit Kumar Sharma
- Department of Burns and Plastic Surgery, SMS Hospital, Jaipur, Rajasthan, India
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Abstract
PURPOSE OF REVIEW Fecal incontinence is a common problem among women, affecting between 2 and 7% of the general population. Although pelvic reconstructive surgeons have had many effective tools and techniques to treat other pelvic floor disorders, including pelvic organ prolapse and urinary incontinence, there has been a shortage of effective treatment options for fecal incontinence. RECENT FINDINGS In the past few years, however, we have witnessed the introduction of several novel and intriguing treatments for this socially disabling condition. This renaissance of innovation speaks to the recognition that fecal incontinence is a significant pelvic floor disorder that we have not adequately addressed. Recent studies include research on a novel vaginal device to treat fecal incontinence, as well as long-term and comparative studies on neuromodulation, perianal bulking and transanal radiofrequency energy. There have also been recent studies on several novel, yet still unapproved, implantable devices, including a self-affixing rectal sling and a magnetic sphincter. SUMMARY In the not-too-distant future, it appears that pelvic reconstructive surgeons will have a vast armamentarium of tools to manage one of the more vexing pelvic floor conditions we face in our daily practice. With the introduction of these new treatments, it will be important to develop a logical algorithm in our approach to fecal incontinence.
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Meyer I, Richter HE. Impact of fecal incontinence and its treatment on quality of life in women. ACTA ACUST UNITED AC 2015; 11:225-38. [PMID: 25776296 DOI: 10.2217/whe.14.66] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Fecal incontinence (FI) is a physically and psychosocially debilitating disorder which negatively impacts quality of life (QOL). It bears a significant burden not only on patients but also on their families, caretakers as well as society as a whole. Even though it is considered a somewhat common condition, especially as women age, the prevalence is often underestimated due to patients' reluctance to report symptoms or seek care. The evaluation and treatment of FI can be also hindered by lack of understanding of the current management options among healthcare providers and how they impact on QOL. This article provides a comprehensive review on the impact of FI and its treatment on QOL in women.
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Affiliation(s)
- Isuzu Meyer
- Division of Urogynecology & Pelvic Reconstructive Surgery, Department of Obstetrics & Gynecology, University of Alabama at Birmingham, 1700 6th Avenue South, Suite 10382, Birmingham, AL 35233, USA
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Montroni I, Wexner SD. Reoperative surgery for fecal incontinence. SEMINARS IN COLON AND RECTAL SURGERY 2015. [DOI: 10.1053/j.scrs.2015.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Meyer I, Richter HE. Evolving Surgical Treatment Approaches for Fecal Incontinence in Women. CURRENT OBSTETRICS AND GYNECOLOGY REPORTS 2015. [DOI: 10.1007/s13669-015-0116-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Meyer I, Richter HE. An Evidence-Based Approach to the Evaluation, Diagnostic Assessment and Treatment of Fecal Incontinence in Women. CURRENT OBSTETRICS AND GYNECOLOGY REPORTS 2014; 3:155-164. [PMID: 25505643 PMCID: PMC4258837 DOI: 10.1007/s13669-014-0085-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Fecal incontinence (FI) is a debilitating disorder which negatively impacts quality of life. The etiology is often multifactorial and although most women with FI are able to be treated, many remain untreated because a significant proportion of women do not report their symptoms and seek care. The evaluation and treatment of FI can be also hindered by a lack of understanding of the mechanisms and current options. This article provides a review on the evidence-based evaluation and management for FI.
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Affiliation(s)
- Isuzu Meyer
- Division of Urogynecology and Pelvic Reconstructive Surgery, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL, 1700 6th Avenue South, Suite 10382, Birmingham, AL 35233, ,
| | - Holly E Richter
- Division of Urogynecology and Pelvic Reconstructive Surgery, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL, 1700 6th Avenue South, Suite 10382, Birmingham, AL 35233, ,
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Lam TJ, Visscher AP, Meurs-Szojda MM, Felt-Bersma RJF. Clinical response and sustainability of treatment with temperature-controlled radiofrequency energy (Secca) in patients with faecal incontinence: 3 years follow-up. Int J Colorectal Dis 2014; 29:755-61. [PMID: 24805249 DOI: 10.1007/s00384-014-1882-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/23/2014] [Indexed: 02/04/2023]
Abstract
BACKGROUND Controlled delivery of radio frequent energy (Secca) has been suggested as treatment for faecal incontinence (FI). OBJECTIVE The objective of the study is to evaluate clinical response and sustainability of Secca for FI. DESIGN This is a prospective cohort study. PATIENTS This study involved patients who had failed full conservative management for FI. INTERVENTIONS This study was performed between 2005 and 2010. MAIN OUTCOME MEASURES FI was scored using the Vaizey score (VS). A clinically significant response to Secca was defined as ≥50 % reduction in incontinence score. Impact of FI on quality of life (QOL) was measured using the FIQL. Data was obtained at baseline, at 6 months and at 1 and 3 years. Anal endosonography and anal manometry were performed at 3 months and compared to baseline. RESULTS Thirty-one patients received Secca. During follow-up, 5/31 (16 %), 3/31 (10 %) and 2/31 (6 %) of patients maintained a clinically significant response after the Secca procedure. Mean VS of all patients was 18 (SD 3), 14 (SD 4), 14 (SD 4) and 15 (SD 4), at baseline, 6 months and 1 and 3 years. No increases in anorectal pressures or improvements in rectal compliance were found. Coping improved between baseline and t = 6 months. No predictive factors for success were found. LIMITATIONS This is a non-randomised study design. CONCLUSION This prospective non-randomised trial showed disappointing outcomes of the Secca procedure for the treatment of FI. The far minority of patients reported a clinically significant response of seemingly temporary nature. Secca might be valuable in combination with other interventions for FI, but this should be tested in strictly controlled randomised trials.
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Affiliation(s)
- T J Lam
- Department of Gastroenterology and Hepatology, VU University Medical Center, P.O. box 7057, 1007 MB, Amsterdam, The Netherlands
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Frascio M, Mandolfino F, Imperatore M, Stabilini C, Fornaro R, Gianetta E, Wexner SD. The SECCA procedure for faecal incontinence: a review. Colorectal Dis 2014; 16:167-172. [PMID: 24034552 DOI: 10.1111/codi.12403] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2013] [Accepted: 08/03/2013] [Indexed: 12/13/2022]
Abstract
AIM The SECCA system is a treatment option for patients with faecal incontinence and was introduced into clinical practice in 2002. Clinical studies of radiofrequency energy to treat patients with faecal incontinence have been published. This article aimed to review all published series to assess the results of this treatment. METHOD Twelve studies were included. Outcomes analysed included quality of life, the Wexner incontinence score, anorectal manometry and endoanal ultrasound findings. RESULTS A total of 220 patients from 10 studies were included. In the majority of clinical studies, the SECCA procedure has been shown to be an effective treatment of mild-to-moderate faecal incontinence. CONCLUSION When patient selection is appropriate, this treatment has demonstrated clinically significant improvements in symptoms, as demonstrated by statistically significant reductions in the Wexner incontinence and quality of life scores.
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Affiliation(s)
- M Frascio
- Patologia Chirurgica ad Indirizzo Gastroenterologico, DISC-Department of Surgical Sciences and Integrated Methodologies, School of Medical and Pharmaceutical Sciences, University of Genova, Genova, Italy
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Koughnett JAMV, Wexner SD. Current management of fecal incontinence: Choosing amongst treatment options to optimize outcomes. World J Gastroenterol 2013; 19:9216-9230. [PMID: 24409050 PMCID: PMC3882396 DOI: 10.3748/wjg.v19.i48.9216] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2013] [Revised: 09/17/2013] [Accepted: 11/05/2013] [Indexed: 02/06/2023] Open
Abstract
The severity of fecal incontinence widely varies and can have dramatic devastating impacts on a person’s life. Fecal incontinence is common, though it is often under-reported by patients. In addition to standard treatment options, new treatments have been developed during the past decade to attempt to effectively treat fecal incontinence with minimal morbidity. Non-operative treatments include dietary modifications, medications, and biofeedback therapy. Currently used surgical treatments include repair (sphincteroplasty), stimulation (sacral nerve stimulation or posterior tibial nerve stimulation), replacement (artificial bowel sphincter or muscle transposition) and diversion (stoma formation). Newer augmentation treatments such as radiofrequency energy delivery and injectable materials, are minimally invasive tools that may be good options before proceeding to surgery in some patients with mild fecal incontinence. In general, more invasive surgical treatments are now reserved for moderate to severe fecal incontinence. Functional and quality of life related outcomes, as well as potential complications of the treatment must be considered and the treatment of fecal incontinence must be individualized to the patient. General indications, techniques, and outcomes profiles for the various treatments of fecal incontinence are discussed in detail. Choosing the most effective treatment for the individual patient is essential to achieve optimal outcomes in the treatment of fecal incontinence.
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Towliat SM, Mehrvarz S, Mohebbi HA, Sate Bigdeli A. Outcomes of rectal prolapse using the altemeier procedure. IRANIAN RED CRESCENT MEDICAL JOURNAL 2013; 15:620-621. [PMID: 24396587 PMCID: PMC3871755 DOI: 10.5812/ircmj.3666] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/08/2011] [Revised: 07/15/2012] [Accepted: 04/16/2013] [Indexed: 11/16/2022]
Affiliation(s)
- Seyed Mohsen Towliat
- Research Center for Gastroenterology and Liver Disease, Baqiyatallah University of Medical Sciences, Tehran, IR Iran
| | - Shaban Mehrvarz
- Trauma Research Center, Baqiyatallah University of Medical Sciences, Tehran, IR Iran
| | - Hassan Ali Mohebbi
- Trauma Research Center, Baqiyatallah University of Medical Sciences, Tehran, IR Iran
| | - Ali Sate Bigdeli
- Department of surgery Baqiyatallah University of Medical Sciences, Baqiyatallah University of Medical Sciences, Tehran, IR Iran
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Ruiz D, Pinto RA, Hull TL, Efron JE, Wexner SD. Does the radiofrequency procedure for fecal incontinence improve quality of life and incontinence at 1-year follow-up? Dis Colon Rectum 2010; 53:1041-6. [PMID: 20551757 DOI: 10.1007/dcr.0b013e3181defff8] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PURPOSE Fecal incontinence is a socially isolating disease that causes physical and psychologic distress. Radiofrequency delivered to the anal canal is a surgical modality for fecal incontinence that has been noted to be safe and potentially effective. The aim of this study was to evaluate improvement in fecal incontinence and quality of life after the radiofrequency procedure at 1-year follow-up. METHODS After institutional review board approval, patients with fecal incontinence for at least 3 months were prospectively recruited between March 2003 and June 2004. Patients enrolled in the study underwent the Secca procedure. The Cleveland Clinic Florida Fecal Incontinence Score and the Fecal Incontinence Quality of Life Questionnaire were completed at the first visit and then at 12-month follow-up. Wilcoxon signed rank test was used to analyze the difference between baseline and follow-up. RESULTS A total of 24 patients (23 females) were enrolled in the study, and 16 were available at the 12-month follow-up visit. The main causes of fecal incontinence were either idiopathic or included obstetric injury, aging, and trauma from previous anorectal surgeries. The mean operative time was 45.5 +/- 8.3 minutes, and the mean number of radiofrequency lesions in the anal canal was 65.5 +/- 13.8. There were 3 self-limited episodes of postoperative bleeding and 1 instance of constipation that was resolved with laxatives. There were no delayed complications. The mean Cleveland Clinic Florida Fecal Incontinence Score improved from a mean of 15.6 (+/- 3.2) at baseline to 12.9 (+/- 4.6) at 12 months (P = .035). The mean Fecal Incontinence Quality of Life Questionnaire score improved in all subsets except for the depression subscore. CONCLUSION Radiofrequency is a safe, minimally invasive tool for treating patients with fecal incontinence. Improvement in fecal incontinence and quality of life was maintained at 12 months without delayed morbidity. The actual significance of this improvement is yet to be determined.
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Affiliation(s)
- Dan Ruiz
- Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, Florida 33331, USA
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Abstract
Fecal incontinence is a devastating underestimated problem, affecting a large number of individuals all over the world. Most of the available literature relates to the management of adults. The treatments proposed are not uniformly successful and have little application in the pediatric population. This paper presents the experience of 30 years, implementing a bowel management program, for the treatment of fecal incontinence in over 700 pediatric patients, with a success rate of 95%. The main characteristics of the program include the identification of the characteristics of the colon of each patient; finding the specific type of enema that will clean that colon and the radiological monitoring of the process.
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Affiliation(s)
- Andrea Bischoff
- Colorectal Center for Children, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, ML 2023, Cincinnati, OH 45229 USA
| | - Marc A. Levitt
- Colorectal Center for Children, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, ML 2023, Cincinnati, OH 45229 USA
| | - Alberto Peña
- Colorectal Center for Children, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, ML 2023, Cincinnati, OH 45229 USA
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Takahashi-Monroy T, Morales M, Garcia-Osogobio S, Valdovinos MA, Belmonte C, Barreto C, Zarate X, Bada O, Velasco L. SECCA procedure for the treatment of fecal incontinence: results of five-year follow-up. Dis Colon Rectum 2008; 51:355-9. [PMID: 18204954 DOI: 10.1007/s10350-007-9169-0] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2006] [Revised: 11/28/2006] [Accepted: 05/26/2007] [Indexed: 01/20/2023]
Abstract
PURPOSE This study evaluated the long-term (5-year) durability of radiofrequency energy delivery for fecal incontinence. METHODS This was an extension of the follow-up from our original prospective study in which patients who suffered from fecal incontinence were treated with the SECCA system for radiofrequency energy delivery to the anal canal muscle. The Cleveland Clinic Florida Fecal Incontinence Scale (0-20), fecal incontinence-related quality of life score, and Medical Outcomes Study Short-Form 36 were administered to five years. Differences between baseline and follow-up were analyzed by using paired t-test. RESULTS A total of 19 patients were treated and followed for five years, including 18 females (aged 57.1 (range, 44-77) years). The mean duration for fecal incontinence was 7.1 (range, 1-21) years. At five-year follow-up, the mean fecal incontinence score had improved from 14.37 to 8.26 (P<0.00025) with 16 patients (84.2 percent) demonstrating>50 percent improvement. All fecal incontinence-related quality of life scores improved, including lifestyle (2.43 to 3.15; P<0.00075), coping (1.73 to 2.6; P<0.00083), depression (2.24 to 3.15; P<0.0002), and embarrassment (1.56 to 2.51; P<0.0003). The social function component of the Short-Form 36 improved from 38.3 to 60 (P<0.05). There was a trend toward improvement in the mental component summary of the Short-Form 36 from 38.1 to 48.14. There were no long-term complications. CONCLUSIONS Significant and sustained improvements in fecal incontinence symptoms and quality of life are seen at five years after treatment with the SECCA system. This treatment should be considered for patients suffering from fecal incontinence not amenable to surgery and who have failed conservative management.
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Affiliation(s)
- Takeshi Takahashi-Monroy
- Service of Colon and Rectal Surgery, Department of Surgery, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico, DF, Mexico.
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