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J. coloproctol. (Rio J., Impr.) ; 41(1): 52-57, Jan.-Mar. 2021. tab
Article in English | LILACS | ID: biblio-1286964


Abstract Objective To compare the fecal incontinence status of patients submitted to theAltemeier procedure with or without posterior levatorplasty. Materials and Methods Medical records of the patients who underwent the Altemeier procedure at Shahid Faghihi Hospital (in Shiraz, Iran) from 2014 to 2018 were retrospectively studied. Patients older than 17 years of age who underwent the Altemeier procedure due to complete rectal prolapse were considered. In some cases, the operation was performed with posterior levatorplasty. Rectal prolapse due to collagen or connective tissue disorders, anal/sacral anomalies, immunodeficiency, history of rectal surgery, and pelvic radiotherapy were the exclusion criteria of the present study. In addition to the demographics (including age, gender, and body mass index), the fecal incontinence status of each case was determined through theWexner scale preoperatively and 12 months after the surgery. The incontinence scores were then compared against the baseline values of the two groups of patients: those with and those without posterior levatorplasty. The statistical analysis was performed using the Statistical Package for the Social Sciences (SPSS, IBM Corp., Armonk, NY, US), software, version 21. Results In total, 53 patients (17 men and 36 women) with a mean age of 55.23 ± 18.24 years were analyzed. The comparison of the pre- and postoperative scores on theWexner scale between the two groups revealed no statistically significant difference (p >0.05). Conclusion Posterior levatorplasty during the Altemeier procedure did not result in significant improvement of the fecal incontinence outcome of the patients.

Resumo Objetivo Comparar o status de incontinência fecal de pacientes após o procedimento de Altemeier com e sem levatorplastia posterior. Materiais e métodos Os prontuários médicos dos pacientes submetidos ao procedimento de Altemeier no Shahid Faghihi Hospital (em Shiraz, Irã) entre 2014 e 2018 foram avaliados retrospectivamente. Pacientes com idade superior a 17 anos submetidos ao procedimento de Altemeier devido a prolapso retal completo foram considerados. Em alguns casos, a operação foi realizada com levatorplastia posterior. Prolapso retal devido a distúrbios de colágeno ou do tecido conjuntivo, anomalias anais/sacrais, imunodeficiência, histórico de cirurgia retal, e radioterapia pélvica foram os critérios de exclusão deste estudo. Além dos dados demográficos (incluindo idade, sexo, e índice de massa corporal), o status da incontinência fecal de cada caso foi determinado por meio da escala de Wexner antes e doze meses após a cirurgia. Então, as pontuações de incontinência foram comparadas aos valores de referência dos dois grupos de pacientes: com e sem levatorplastia posterior. A análise estatística foi feita usandose o programa Statistical Package for the Social Sciences (SPSS, IBM Corp., Armonk, NY, EUA), versão 21. Resultados No total, 53 pacientes (17 homens e 36 mulheres) com idade média de 55.23 ± 18.24 anos foramavaliados. A comparação entre os grupos das pontuações na escala de Werner no pré e pós-operatório não revelou diferença estatisticamente significativa (p>0.05). Conclusão Levatorplastia superior durante o procedimento de Altemeier não resultou em melhora significativa do desfecho da incontinência fecal dos pacientes.

Humans , Male , Female , Postoperative Complications/etiology , Rectum/surgery , Rectal Prolapse/complications , Fecal Incontinence/etiology
J. coloproctol. (Rio J., Impr.) ; 41(1): 30-36, Jan.-Mar. 2021. tab, graf
Article in English | LILACS | ID: biblio-1286963


Abstract Objective Several techniques are used to repair the anal sphincter following injury. The aim of the present study is to comprehensively analyze the short- and long-term outcomes of overlap repair following anal sphincter injury. Methods A search was conducted in the PubMed, Medline, Embase, Scopus and Google Scholar databases between January 2000 and January 2020. Studies that described the outcomes that are specific to overlap sphincter repair for fecal incontinence with a minimum follow-up period of one year were selected. Results A total of 22 studies described the outcomes of overlap sphincter repair. However, 14 studies included other surgical techniques in addition to overlap repair, and were excluded from the analysis. Finally, data from 8 studies including 429 repairs were analyzed. All studies used at least one objective instrument; however, there was significant heterogeneity among them. Most patients were female (n=407; 94.87%) and the mean age of the included individuals was 44.6 years. The majority of the procedures were performed due to obstetric injuries (n=384; 89.51%). The eight included studies described long-term outcomes, and seven of them demonstrated statistically significant improvements regarding the continence; one study described poor outcomes in terms of overall continence. The long-term scores were significantly better compared with the preoperative scores. However, compared with the shortterm scores, a statistically significant deterioration was noted in the long-term. Conclusion The majority of the studies described good long-term outcomes in terms of anal continence after overlap sphincter repair. However, further studies are needed

Resumo Objetivo Diversas técnicas são usadas no reparo do esfíncter anal após lesões. O objetivo deste estudo é fazer uma análise completa dos desfechos nos curto e longo prazos do reparo por sobreposição após lesão do esfíncter anal. Métodos Realizou-se uma busca nas bases de dados PubMed, Medline, Embase, Scopus e Google Scholar entre janeiro de 2000 e janeiro de 2020. Estudos que descreviam desfechos específicos do reparo de esfíncter por sobreposição para incontinência fecal, com um mínimo de 1 ano de seguimento, foram selecionados. Resultados No total, 22 estudos descreviam os desfechos do reparo de esfíncter por sobreposição. No entanto, 14 estudos incluíam outras técnicas cirúrgicas além do reparo por sobreposição, e foram excluídos da análise. Por fim, dados de 8 estudos que incluíam 429 reparos foram analisados. Todos os estudos usaram pelo menos um instrumento objetivo, mas havia uma heterogeneidade significativa entre eles. A maioria dos pacientes era do sexo feminino (n=407; 94,87%), e a idade média dos indivíduos incluídos foi de 44,6 anos. A maioria das cirurgias foi realizada devido a lesões obstétricas (n=384; 89,51%). Os oito estudos incluídos descreveram os desfechos no longo prazo, e sete deles demonstraram melhoras estatisticamente significativas com relação à continência; um estudo descreveu resultados ruins em termos gerais com relação à continência. As pontuações no longo prazo foram significativamente melhores em comparação com as pontuações no pré-operatório. No entanto, em comparação com as pontuações no curto prazo, percebeu-se uma piora estatisticamente significativa no longo prazo. Conclusão A maioria dos estudos descrevia bons resultados no longo prazo em termos de continência anal depois do reparo do esfíncter por sobreposição. Entretanto mais estudos são necessários para que se identifiquem os fatores associados aos desfechos ruins para auxiliar na seleção de pacientes para o reparo por sobreposição.

Humans , Male , Female , Anal Canal/surgery , Anal Canal/injuries , Rectal Diseases/surgery , Fecal Incontinence/etiology
Säo Paulo med. j ; 139(1): 58-64, Jan.-Feb. 2021. tab, graf
Article in English | LILACS | ID: biblio-1156971


ABSTRACT BACKGROUND: The results from sphincteroplasty may worsen over time. Reseparation of the rectum and vagina/scrotum in conjunction with sphincteroplasty achieves good results. Improving the surgical effect of sphincteroplasty through perineal body reconstruction is crucial. OBJECTIVE: To evaluate the long-term results from anterior sphincteroplasty and perineal body reconstruction (modified sphincteroplasty) among patients with traumatic sphincter injury. DESIGN AND SETTING: Retrospective study among patients who underwent modified sphincteroplasty in a university hospital between January 2006 and December 2018. Fifty patients were evaluated in detail. METHODS: The following variables were evaluated: gender, age, additional disease status, time interval between trauma and surgery, surgical technique, duration of hospitalization, follow-up period after surgery, manometric values, electromyography results, magnetic resonance imaging scans, Wexner scores, satisfaction levels with surgery and surgical outcomes. RESULTS: The patients' mean age was 44.6 ± 15.1 years. The median follow-up period was 62 months (range, 12-118). The mean Wexner scores preoperatively, postoperatively in first month (M1S) and at the time of this report (AAS) were 15.5 ± 3.2, 1.9 ± 3.15 and 3.9 ± 5.3, respectively. Although improvements in the patients' mean Wexner scores became impaired over time, the postoperative Wexner scores were still significantly better than the preoperative Wexner scores (P = 0.001). CONCLUSION: Good or excellent results were obtained surgically among patients with traumatic sphincter injury. Performing perineal body reconstruction in addition to sphincteroplasty can provide better long-term continence. Surgical outcomes were found to be better, especially among patients younger than 50 years of age and among patients who underwent surgery within the first five years after trauma.

Humans , Male , Female , Adult , Middle Aged , Fecal Incontinence/surgery , Fecal Incontinence/etiology , Anal Canal/surgery , Vagina , Retrospective Studies , Treatment Outcome
Arch. argent. pediatr ; 118(5): 350-357, oct 2020. tab, ilus
Article in Spanish | LILACS, BINACIS | ID: biblio-1122544


La enfermedad de Hirschsprung ocurre en 1 de cada 5000 nacimientos. La falla de migración de las células ganglionares desde la cresta neural en dirección cefalocaudal genera su ausencia en parte o todo el colon. Se manifiesta con falta de eliminación de meconio, distensión abdominal y dificultades en la evacuación. Luego del tratamiento quirúrgico, existen complicaciones a corto y largo plazo. El objetivo de esta publicación es describir las principales causas de síntomas persistentes en los pacientes operados por enfermedad de Hirschsprung y presentar un algoritmo diagnóstico-terapéutico factible de ser realizado en nuestro medio

Hirschsprung disease is characterized by the lack of migration of intrinsic parasympathetic ganglia from neural crest and consequently absence of them at varying length of the bowel, resulting in functional obstruction. The incidence is 1 per 5000 births. After surgery, short term and long term comorbidity commonly occurs. The aim of this article is to revise the main causes of ongoing symptoms after surgery in Hirschsprung disease patients and to show a diagnostic and therapeutic algorithm that can be developed in our community

Humans , Hirschsprung Disease/surgery , Hirschsprung Disease/diagnosis , Hirschsprung Disease/therapy , Pediatrics , Chronic Disease , Constipation/diet therapy , Constipation/etiology , Enterocolitis/diet therapy , Enterocolitis/etiology , Fecal Incontinence/diet therapy , Fecal Incontinence/etiology
Rev. chil. obstet. ginecol. (En línea) ; 85(3): 201-207, jun. 2020.
Article in Spanish | LILACS | ID: biblio-1126154


RESUMEN El parto vaginal se asocia con un riesgo más alto de daño perineal, incontinencia urinaria y fecal comparado con el parto cesárea. Dicho riesgo aumenta con el parto instrumental (ej. fórceps) y disminuye cuando la posición al momento del parto reduce la compresión sobre el sacro o si el parto ocurre bajo el agua. En otros factores que aumentan el riesgo de incontinencia se incluyen: la gran multiparidad, la duración del trabajo de parto, el peso fetal y tamaño de su cabeza, la edad muy joven al momento del primer parto, la inducción del trabajo de parto, la obesidad, la diabetes, la constipación, el tabaquismo y la historia de incontinencia urinaria o fecal. Factores sociales que se asocian a incontinencia incluyen la falta de educación, malas condiciones de hábitat, trabajo manual intenso, la falta de actividad física y el divorcio.

ABSTRACT Vaginal delivery is associated with a higher risk of perineal injury, and urinary and fecal incontinence as compared with caesarean delivery; The risk is higher in case of operative vaginal delivery and lower if the position at delivery takes the weight off the sacrum or is carried out under water immersion; A number of other factors increase the risk of incontinence, including higher parity, duration of labour, fetal weight or size of fetal head, younger age at first delivery, induction of labour, obesity, diabetes, constipation, smoking and history of urinary or fecal incontinence. Social factors such as lack of education, poor living environment, intense manual labour, the absence of physical exercise and divorce, are also associated with incontinence.

Humans , Female , Pregnancy , Perineum/injuries , Urinary Incontinence/etiology , Cesarean Section/adverse effects , Delivery, Obstetric/adverse effects , Fecal Incontinence/etiology
ABCD arq. bras. cir. dig ; 33(3): e1545, 2020. tab, graf
Article in English | LILACS | ID: biblio-1152621


ABSTRACT Background: Several types of complications including constipation, fecal soiling, perianal excoriation, were reported among different types of surgery for Hirschsprung's disease. Aim: To compare circular and oblique anastomoses following Soave's procedure for the treatment of Hirschsprung's disease. Methods: Children who underwent Saove's pull through procedure with oblique and circular anastomoses were included. Duration of the follow up was two years after surgery. Postoperative complications, such as wound infection, wound dehiscence, peritonitis, fecal soiling, perianal excoriation, were recorded for each patient. Results: Thirty-eight children underwent oblique anastomoses. Circular ones were done for 32 children. Perianal excoriation was seen in 57.89% and 46.87% of children in oblique and circular group, respectively. Enterocolitis was more frequent in circular (40.62%) than oblique (28.94%) group. Anastomotic stricture was more frequent in circular (15.62%) than oblique (7.89%). Conclusion: Perianal excoriation was the most common complication among patient in both groups. Oblique anastomoses had fewer complications than circular, and may be appropriate option for patient who underwent Soave's procedure.

RESUMO Racional: Vários tipos de complicações, incluindo constipação, secreção fecal, escoriação perianal foram relatadas entre diferentes tipos de operações para a doença de Hirschsprung. Objetivo: Comparar as anastomoses circulares e oblíquas realizadas no procedimento de Soave para o tratamento da doença de Hirschsprung. Métodos: Neste estudo, foram incluídas crianças submetidas ao procedimento pull-through de Saove com anastomoses oblíquas e circulares. A duração do acompanhamento foi de dois anos no pós-operatório. Complicações, como infecção da ferida, deiscência da ferida, peritonite, secreção fecal, escoriação perianal foram registradas para cada paciente. Resultados: Trinta e oito crianças foram submetidas à anastomoses oblíquas. As circulares foram realizadas em 32. Escoriação perianal foi observada em 57,89% e 46,87% das crianças nos grupos oblíquo e circular, respectivamente. Enterocolite foi mais frequente no grupo circular (40,62%) do que oblíquo (28,94%). A estenose anastomótica foi mais frequente na circular (15,62%) do que na oblíqua (7,89%). Conclusão: A escoriação perianal foi a complicação mais comum entre os pacientes nos dois grupos. A anastomose oblíqua teve menos complicações do que a anastomose circular e pode ser a opção adequada para o paciente submetido ao procedimento de Soave.

Humans , Infant , Child , Digestive System Surgical Procedures/methods , Anastomosis, Surgical/methods , Constipation/etiology , Fecal Incontinence/etiology , Hirschsprung Disease/surgery , Postoperative Complications/epidemiology , Digestive System Surgical Procedures/instrumentation , Follow-Up Studies , Treatment Outcome , Proctocolectomy, Restorative/methods , Hirschsprung Disease/diagnosis
Rev. argent. coloproctología ; 30(2): 51-56, Jun. 2019. tab
Article in Spanish | LILACS | ID: biblio-1025473


Introducción: La incontinencia anal es una compleja y devastadora patología que altera la calidad de vida de los pacientes, cuya etiología más común es la lesión esfintérica postparto vaginal. A la hora de clasificar la incontinencia, el score descripto por Jorge y Wexner es el más utilizado en nuestro medio. La ecografía endoanal ha sido definida como el gold standard para evaluar los defectos del esfínter anal. Objetivo: Determinar la correlación entre los hallazgos clínicos y ecográficos en pacientes con incontinencia fecal de causa obstétrica. Material y Métodos: Población: pacientes que consultaron en el Centro Privado de Cirugía y Coloproctología entre enero de 2015 y diciembre de 2017 por incontinencia fecal con antecedentes de trauma obstétrico y a las que se les realizó una ecografía endoanal 360° y score de Jorge y Wexner. Resultados: Se evaluaron 24 pacientes. La media de edad fue de 56 años. El número de partos en promedio fue 2,3 y el Score de Wexner en promedio fue 9.7 (±5.2). La ecografía endoanal confirmó alteración esfintérica por afinamiento o interrupción en el 100% de los pacientes. Se observó una tendencia a una asociación negativa entre el Score de Wexner y la ecografía endoanal (r=-0.328, p=0.067). Las pacientes con menor grado de lesión esfinteriana por ecografía tenían mayor severidad en el Score de Wexner que las pacientes con mayor grado de lesión. Las pacientes con evidencia ecográfica de lesiones leves refirieron un mayor Score de Wexner que aquellas con lesiones severas. Conclusión: En este trabajo no existió correlación entre los hallazgos ecográficos y el score de incontinencia. Si bien la ecografía esfintérica es el gold standard para evaluar daño muscular, la terapéutica no debe ser determinada solamente por la ecografía. Tipo de estudio: Retrospectivo, transversal y descriptivo.

Introduction: Anal incontinence is a complex and devastating pathology that alters the patient's quality of life, whose most common etiology is vaginal postpartum sphincter injury. To classify incontinence, the score described by Jorge and Wexner is the most used in our environment. Endoanal ultrasound has been defined as the gold standard for evaluating anal sphincter defects. Objective: To determine the correlation between clinical and ultrasound findings in patients with fecal incontinence due to obstetric cause. Material and Methods: Population: patients who consulted at the Private Center of Surgery and Coloproctology between January 2015 and December 2017 due to fecal incontinence with a history of obstetric trauma and who underwent a 360º endoanal ultrasound and a Jorge and Wexner score. Results: Twenty-four patients were evaluated. The average age was 56 years. The number of births on average was 2.3 and the Wexner Score on average was 9.7 (± 5.2). Endoanal ultrasound confirmed sphincter alteration by refining or interruption in 100% of patients. A tendency to a negative association was observed between the Wexner Score and the endoanal ultrasound (r = -0.328, p = 0.067). Patients with a lower degree of sphincter injury by ultrasound had greater severity in the Wexner Score than patients with a higher degree of injury. Patients with ultrasound evidence of mild lesions reported a higher Wexner Score than those with severe lesions. Conclusion: In this work, there was no correlation between the sonographic findings and the incontinence score. Although sphincter ultrasonography is the gold standard for assessing muscle damage, therapy should not be determined only by ultrasound. Type of study: Retrospective, cross-sectional and descriptive.

Humans , Female , Pregnancy , Adult , Middle Aged , Aged , Aged, 80 and over , Anal Canal/injuries , Anal Canal/diagnostic imaging , Endosonography/methods , Fecal Incontinence/etiology , Risk Factors , Fecal Incontinence/diagnostic imaging , Obstetric Labor Complications
Rev. argent. coloproctología ; 30(2): 65-70, Jun. 2019. ilus, tab
Article in Spanish | LILACS | ID: biblio-1025568


Introducción: Las fístulas perianales tienen dos problemas fundamentales, la tasa de recurrencia y de incontinencia fecal postoperatoria, complicaciones que varían en frecuencia dependiendo de varios factores como el tipo de fistula, la técnica quirúrgica usada y la experiencia del cirujano. Debido a esto existen técnicas quirúrgicas no conservadoras y conservadoras de esfínteres donde se incluye el tratamiento video asistido que aparece desde el año 2006 y en la cual se utiliza un sistema de video endoscopio sofisticado y de alto valor económico el cual hemos adaptado a nuestro medio. Pacientes y método: De septiembre del 2015 al 2017 en la Unidad de Coloproctología del Hospital Domingo Luciani IVSS se realizó un estudio prospectivo experimental, donde se incluyeron 18 pacientes con fístulas perianales complejas diagnosticadas previamente con Ecofistulografía 3D y los cuales se operaron con un sistema adaptado usando citoscopio pediátrico de 4 mm y energía láser. Se evaluaron parámetros referentes a la técnica así como la tasa de éxito y riesgo de incontinencia. Resultados: Tiempo quirúrgico de 40 a 80 minutos, con tasa de éxito de 89%, recidiva en 2 pacientes, con tiempo de seguimiento entre 12 a 36 meses y sin cambios en la escala de incontinencia pre y post quirúrgica. Conclusión: El tratamiento video asistido modificado para fistulas anales (VAMAFT) es una técnica innovadora y factible de realizar al adaptar algunos instrumentos, con una tasa de éxito adecuada y sin riesgo de incontinencia, pero más trabajos aleatorizados con mayor números de pacientes deben ser realizados.

Introduction: Anal fistulas have two basic problems, rate of recurrence and postoperative anal incontinence. These complications vary according to several factors such as type of anal fistula, surgical technique and the surgeon´s experience. For each cases there are different surgical techniques with and without conservation of anal sphincters like conservative video assisted anal fistula treatment, described in 2006, this technique uses a sophisticated and expensive endoscope system but that we modified to use in our hospitals. Patients and method: Between September 2015 to 2017 in the Unit of Coloproctology of Domingo Luciani Hospital, was perfomed a prospective and experimental trial in 18 patients with anal complex fistulas previously diagnosed using tridimensional anal ultrasound and operated with a modified system consisting of pediatric cystoscope of 4 mm and laser energy. Some parameters were evaluated including surgical technique, recurrence and anal incontinence rate. Results: Surgical times were between 40 to 80 minutes, success rate of 89%, recurrence in two patients with follow up of 12 to 36 months and no changes in pre and post surgical anal incontinence scale. Conclusion: Video assited modified anal fistula treatment (VAMAFT) is an innovative and feasible surgical technique to do adapting some instruments, with suitable success rate and without anal incontinence risk but many randomized research with more patients have to be perfomed.

Humans , Male , Female , Adult , Middle Aged , Aged , Young Adult , Rectal Fistula/surgery , Rectal Fistula/diagnosis , Video-Assisted Surgery/methods , Postoperative Complications , Recurrence , Fecal Incontinence/etiology
Rev. cir. (Impr.) ; 71(2): 178-186, abr. 2019. tab, ilus
Article in Spanish | LILACS | ID: biblio-1058253


En los últimos 30 años el tratamiento del cáncer del recto ha mejorado significativamente gracias al manejo multidisciplinario y a la introducción del concepto de resección total del mesorrecto (RTM), logrando disminuir las tasas de recidiva local y aumentar la sobrevida. Si bien los avances oncológicos y técnicos en términos de tasas de conservación del esfínter anal son innegables, las secuelas funcionales son significativas, especialmente las relacionadas a la función intestinal, sexual y urinaria. Hasta un 90% de los pacientes sometidos a una RTM refiere secuelas intestinales cuyos síntomas se conocen como el síndrome de la resección anterior baja (SRAB). Recientemente se han diseñado sistemas de valoración específicos que han evidenciado su alta incidencia y prevalencia. En esta revisión se entrega una mirada actualizada de la fisiopatología, factores de riesgo, formas de presentación, evaluación clínica y las distintas alternativas de prevención y tratamiento del SRAB.

In the last 30 years, oncologic outcomes of rectal cancer treatment have been significantly improved due to multimodal management and the introduction of the concept of total mesorectum excision. Although the improvements in oncological treatment and surgical techniques are undeniable, multimodal treatment results in the onset of disorders of the intestinal, sexual and urinary function in a high proportion of these patients. Up to 90% of patients undergoing a low anterior resection refer bowel disorders such as fecal incontinence, urgency, increased frequency and fragmentation of defecation. These elements are included in an entity known as the low anterior resection syndrome and specific assessment tools have been designed recently, evidencing the high incidence and prevalence of this syndrome. In the present review, we update the pathophysiology, risk factors, clinical presentation, evaluation and the alternatives of prevention and treatment of low anterior resection syndrome.

Humans , Male , Female , Postoperative Complications/etiology , Postoperative Complications/therapy , Rectal Neoplasms/surgery , Digestive System Surgical Procedures/adverse effects , Anal Canal/surgery , Anal Canal/physiopathology , Syndrome , Risk Factors , Fecal Incontinence/etiology
Arq. gastroenterol ; 55(supl.1): 47-51, Nov. 2018. tab
Article in English | LILACS | ID: biblio-973911


ABSTRACT BACKGROUND: Scleroderma or progressive systemic sclerosis is characterized by a chronic inflammatory process with proliferation of fibrous connective tissue and excessive deposition of collagen and extracellular matrix in the skin, smooth muscle, and viscera. The smooth muscle most involved in scleroderma is that of the esophagus, and dysphagia is the most commonly reported symptom. However, the internal anal sphincter may also be impaired by degeneration and fibrosis, leading to concomitant anal incontinence in scleroderma patients. These patients may neglect to complain about it, except when actively questioned. OBJECTIVE: To assess anorectal function and anatomy of female scleroderma patients with symptoms of anal incontinence through Cleveland Clinic Florida Fecal Incontinence Score (CCFIS), anorectal manometry and endoanal ultrasound at the outpatient clinic of colorectal and anal physiology, Clinics Hospital, University of São Paulo Medical School (HC-FMUSP). METHODS: Female scleroderma patients were prospectively assessed and questioned as to symptoms of anal incontinence. The anorectal manometry and endoanal ultrasound results were correlated with clinical data and symptoms. RESULTS: In total, 13 women were evaluated. Their mean age was 55.77 years (±16.14; 27-72 years) and their mean disease duration was 10.23 years (±6.23; 2-23 years). All had symptoms of fecal incontinence ranging from 1 to 15. Seven (53.8%) patients had fecal incontinence score no higher than 7; three (23.1%) between 8 and 13; and three (23.1%) 14 or higher, corresponding to mild, moderate, and severe incontinence, respectively. Ten (76.92%) patients had hypotonia of the internal anal sphincter. Three-dimensional endoanal ultrasound showed tapering associated with muscle atrophy of the internal sphincter in six cases and previous muscle defects in three cases. CONCLUSION: A functional and anatomical impairment of the sphincter is an important factor to assess in patients with progressive systemic sclerosis and it should not be underestimated.

RESUMO CONTEXTO: Esclerodermia ou esclerose sistêmica progressiva caracteriza-se por um processo inflamatório crônico com proliferação e fibrose do tecido conjuntivo e uma deposição excessiva de colágeno e matriz extracelular na pele, musculatura lisa e vísceras. A musculatura lisa mais envolvida é a esofágica e a disfagia é o sintoma mais comumente relatado. Entretanto, o esfíncter anal interno também pode ser acometido por essa degeneração e fibrose ocasionando incontinência anal nos pacientes portadores de esclerodermia. Isso pode ser omitido pelo paciente, exceto quando questionado de forma direta. OBJETIVO: Analisar a função e anatomia anorretal através do escore de incontinência anal de Cleveland Clinic Florida, manometria anorretal e ultrassom endoanal em pacientes do sexo feminino portadoras de esclerodermia e sintomas de incontinência anal atendidas no ambulatório de Fisiologia Colorretoanal no Hospital das Clínicas da Universidade de São Paulo (HC-FMUSP). RESULTADOS: Treze pacientes do sexo feminino foram avaliadas com média de idade de 55,77 anos (±16,14; 27-72 anos) e duração média da doença de 10,23 anos (±6,23; 2-23 anos). O índice de incontinência anal teve variação de 1-15, sendo que sete (53,8%) pacientes apresentavam índice inferior a 7; três (23,1%) entre 8 e 13; e três (23,1%) superior a 14, correspondendo à incontinência anal leve, moderada e grave, respectivamente. Dez (76,92%) pacientes apresentavam hipotonia do esfíncter anal interno. O estudo da ultrassonografia endoanal de três dimensões demonstrou afilamento com atrofia do esfíncter anal interno em seis casos e defeito muscular em três pacientes. CONCLUSÃO: O prejuízo funcional e anatômico do complexo esfincteriano anorretal é um importante fator a ser analisado em pacientes portadores de esclerose sistêmica progressiva e isso não pode ser subestimado.

Humans , Male , Female , Adult , Aged , Endosonography/methods , Scleroderma, Diffuse/complications , Fecal Incontinence/diagnostic imaging , Pelvic Floor Disorders/diagnostic imaging , Severity of Illness Index , Prospective Studies , Imaging, Three-Dimensional , Scleroderma, Diffuse/physiopathology , Fecal Incontinence/etiology , Fecal Incontinence/physiopathology , Pelvic Floor Disorders/etiology , Pelvic Floor Disorders/physiopathology , Manometry , Middle Aged
Arq. gastroenterol ; 55(supl.1): 18-24, Nov. 2018. tab, graf
Article in English | LILACS | ID: biblio-973907


ABSTRACT BACKGROUND: There is no a clear knowledge concerning the division of any part of the anal sphincter complex and the effect of this procedure on the function of the anal canal during the treatment of perianal fistula. OBJECTIVE: To evaluate the usefulness of 3D anorectal ultrasound in the assessment of anal fistula, quantifying the length of the sphincter muscle to be transected, selecting patients for different approaches and identifying healing, failure or recurrence after the surgical treatment. METHODS: A prospective study included patients with primarily cryptogenic transsphincteric anal fistula assessed by fecal Incontinence score, tri-dimensional anorectal ultrasound and anal manometry before and after surgery. Based on 3D-AUS, patients with ≥50% external sphincter or external sphincter+puborectalis muscle involvement in males and ≥40% external sphincter or external sphincter+puborectalis muscle in females were referred for the ligation of the intersphincteric tract (LIFT) or seton placement and subsequent fistulotomy; and with <50% involvement in males and <40% in females were referred to one-stage fistulotomy. After surgery, the fibrosis (muscles divided) and residual muscles were measured and compared with the pre-operative. RESULTS: A total of 73 patients was included. The indication for the LIFT was significantly higher in females (47%), one-stage fistulotomy was significantly higher in the males (46%) and similar in seton placement. The minor postoperative incontinence was identified in 31% of patients underwent sphincter divided and were similar in both genders. The 3D-AUS identified seven failed cases. CONCLUSION: The 3D ultrasound was shown to be an effective method in the preoperative assessment of anal fistulas by quantifying the length of muscle to be divided, as the results were similar at the post-operative, providing a safe treatment approach according to the gender and percentage of muscle involvement. Additionally, 3D ultrasound successfully identified the healing tissue and the type of failure or recurrence.

RESUMO CONTEXTO: Não há dados definitivos quanto a níveis diferentes na secção do complexo esfincteriano e o efeito na função do canal anal no tratamento das fístulas anais. OBJETIVO: Avaliar a aplicação do ultrassom anorretal tridimensional no diagnóstico da fístula anal, quantificando o comprimento da musculatura que será seccionada, selecionando pacientes para diferente abordagens e identificando cicatrização e recorrência após tratamento. MÉTODOS: Um estudo prospectivo incluindo paciente portadores de fístula anal criptoglandular, tipo trans-esfinctérica avaliados pelo escore de incontinência fecal, ultrassom anorretal 3D e manometria anorretal antes e após a cirurgia. De acordo com os dados do ultrassom, pacientes do sexo masculino com envolvimento ≥50% do esfíncter externo anterior ou esfíncter externo+puborretal e do sexo feminino com envolvimento ≥40% foram referidos para cirurgia de ligadura do trajeto no espaço inter-esfinctérico (LIFT) ou colocação do sedenho. Aqueles com envolvimento <50% em homens e <40% mulheres foram indicados para fistulotomia em um tempo. Após a cirurgia, a musculatura secccionada (fibrose) e o músculo residual foram medidos e comparados no pós-operatório. RESULTADOS: Um total de 73 pacientes foi incluído. A indicação para LIFT foi significativamente maior em mulheres (47%) e a fistulotomia em homens (46%) e o sedenho similar em ambos os sexos. Sintomas de incontinência leve foi identificado em 31% dos submetidos à cirurgia com divisão de esfíncter e similar em ambos os sexos. O ultrassom identificou sete casos que não cicatrizaram. CONCLUSÃO: O ultrassom anorretal tridimensional demonstrou ser um método efetivo na avaliação da fístula anal, quantificando o comprimento do esfíncter a ser dividido, como demonstrado no resultado pós-operatório, fornecendo um tratamento seguro de acordo com sexo e percentual de músculo envolvido. Adicionalmente, identifica o tecido cicatrizado, tipo de recorrência e a falha no tratamento.

Humans , Male , Female , Adolescent , Adult , Aged , Young Adult , Rectal Fistula/surgery , Rectal Fistula/diagnostic imaging , Endosonography/methods , Fecal Incontinence/etiology , Recurrence , Severity of Illness Index , Prospective Studies , Rectal Fistula/complications , Treatment Outcome , Imaging, Three-Dimensional , Middle Aged
Rev. Assoc. Med. Bras. (1992) ; 62(6): 544-552, Sept. 2016. tab, graf
Article in English | LILACS | ID: biblio-829505


Summary Introduction: Patients operated for correction of anorectal malformations (ARM) can develop fecal incontinence, constipation, and soiling, with loss in quality of life. Objective: To evaluate, through the use of questionnaires, fecal continence, and quality of life of children in the late postoperative follow-up of ARM correction, both high and low. In addition, the levels of fecal continence and quality of life were compared with those of a control group. Method: A Fecal Continence Index Questionnaire (ICF) and a Questionnaire for Assessment of Quality of Life Related to Fecal Continence in Children and Adolescents (QQVCFCA) were administered to 63 patients with ARM, aged from 7 to 19 years, whose surgical treatment had been completed for at least 6 months. The patients were compared to a control group of 59 children. Results: In the control group, 25 (42.4%) patients had good continence and 34 (57.6%), normal continence. We found that the quality of life in children with ARM is compromised globally, in all areas and in the ICF questionnaire, compared to controls (p<0.001). There was no difference between patients with high and low defects. Thirty-two (50.8%) patients had other associated anomalies. Conclusion: In patients operated for ARM correction, quality of life and ICF were compromised, and there was no difference between patients with high-type and low-type of the disease. In about half the cases there are other associated malformations.

Resumo Introdução: os pacientes operados para correção de malformações anorretais (MAR) podem evoluir com incontinência fecal, constipação e soiling, com prejuízo na qualidade de vida. Objetivo: avaliar pela aplicação de questionários a continência fecal e a qualidade de vida de crianças no seguimento pós-operatório tardio de correção de MAR, formas altas e baixas. Também foram comparados os índices de continência fecal e qualidade de vida com um grupo controle de crianças. Método: foram utilizados o Questionário para o Índice de Continência Fecal (ICF) e o Questionário para Avaliar a Qualidade de Vida Relativa à Continência Fecal em Crianças e Adolescentes (QQVCFCA). Os questionários foram aplicados em 63 pacientes de 7 a 19 anos com MAR, com tratamento cirúrgico finalizado há pelo menos 6 meses. Os pacientes foram comparados com um grupo controle de 59 crianças. Resultados: nos pacientes do grupo controle, 25 (42,4%) apresentaram boa continência e 34 (57,6%), normal. A qualidade de vida nas crianças com MAR está comprometida globalmente, em todos os domínios e no ICF, quando comparada com a dos controles (p<0,001). Não houve diferença entre os pacientes com anomalias altas e anomalias baixas. Trinta e dois (50,8%) pacientes apresentaram outras anomalias associadas. Conclusão: nos pacientes operados para correção de MAR, qualidade de vida e ICF foram comprometidos, não havendo diferença entre os pacientes com as formas altas ou baixas da doença. Em cerca de metade dos casos existem outras malformações associadas.

Humans , Male , Female , Child , Adolescent , Young Adult , Quality of Life/psychology , Fecal Incontinence/surgery , Anorectal Malformations/surgery , Time Factors , Case-Control Studies , Surveys and Questionnaires , Fecal Incontinence/etiology , Fecal Incontinence/psychology , Anorectal Malformations/complications , Anorectal Malformations/psychology
Arq. gastroenterol ; 51(3): 198-204, Jul-Sep/2014. tab, graf
Article in English | LILACS | ID: lil-723848


Objectives To evaluate anal sphincter anatomy using three-dimensional ultrasonography (3-DAUS) in incontinent women with vaginal delivery, correlate anatomical findings with symptoms of fecal incontinence and determine the effect of vaginal delivery on anal canal anatomy and function. Methods Female with fecal incontinence and vaginal delivery were assessed with Wexner’s score, manometry, and 3DAUS. A control group comprising asymptomatic nulliparous was included. Anal pressure, the angle of the defect and length of the external anal sphincter (EAS), the anterior and posterior internal anal sphincter (IAS), the EAS + puborectal and the gap were measured and correlated with score. Results Of the 62, 49 had fecal incontinence and 13 were asymptomatic. Twenty five had EAS defects, 8 had combined EAS+IAS defects, 16 had intact sphincters and continence scores were similar. Subjects with sphincter defects had a shorter anterior EAS, IAS and longer gap than women without defects. Those with a vaginal delivery and intact sphincters had a shorter anterior EAS and longer gap than nulliparous. We found correlations between resting pressure and anterior EAS and IAS length in patients with defects. Conclusions Avaliar a anatomia do esfíncter anal usando ultra-sonografia tridimensional (3D-US) em mulheres incontinentes com parto vaginal, correlacionar os achados anatômicos com sintomas de incontinência fecal e, determinar o efeito do parto vaginal sobre a anatomia e função do canal anal. .

Objetivos Avaliar a anatomia do esfíncter anal usando ultra-sonografia tridimensional (3D-US) em mulheres incontinentes com parto vaginal, correlacionar os achados anatômicos com sintomas de incontinência fecal e, determinar o efeito do parto vaginal sobre a anatomia e função do canal anal. Métodos Mulheres com sintomas de incontinência fecal e história de parto vaginal foram avaliadas com escore de Wexner, manometria e 3D-US. Um grupo controle constituído por nulíparas assintomáticas foi incluído. Pressão de repouso, o ângulo radial do defeito e o comprimento do esfíncter anal externo (EAE), o esfíncter anal interno anterior e posterior (EAI), o EAE + músculo puborretal e o gap foram medidos e correlacionados com escore. Resultados Das 62 mulheres, 49 apresentaram sintomas de incontinência fecal e 13 eram nulíparas assintomáticas. Vinte e cinco tinham defeitos EAE, 8 haviam defeito combinado EAS e IAS, 16 tinham esfíncteres intactos e escores de continência foram semelhantes. Indivíduos com defeitos do esfíncter tinha um menor EAE e EAI anterior em relação as mulheres sem defeitos. Aquelas com um parto vaginal e esfíncteres intactos tinham um menor EAE anterior em relação as mulheres nulíparas. Evidenciou-se correlações entre a pressão de repouso e a medida do EAS anterior e IAS em pacientes com defeitos do esfíncter. Conclusões Sintomas de incontinência fecal não se correlacionou com as pressões anais e alterações anatômicas do esfíncter anal, mas as mulheres com defeitos do esfíncter têm menor EAS anterior e IAS e uma gap maior e houve correlações com menor pressão de repouso. .

Adult , Aged , Female , Humans , Middle Aged , Anal Canal/physiopathology , Delivery, Obstetric/adverse effects , Fecal Incontinence/physiopathology , Anal Canal , Case-Control Studies , Endosonography , Fecal Incontinence/etiology , Fecal Incontinence , Imaging, Three-Dimensional , Manometry
Medwave ; 12(3)mar.-abr. 2012. ilus, tab
Article in Spanish | LILACS | ID: lil-714155


Las disfunciones del piso pélvico comprenden la incontinencia urinaria de esfuerzo, el prolapso de órganos pélvicos y la incontinencia anal. Una de cada diez mujeres tendrá que ser sometida a una intervención quirúrgica por disfunciones del piso pélvico durante su vida. Además, entre el 30 por ciento y el 50 por ciento tendrá una recidiva de estas intervenciones. La maternidad es un factor que contribuye de manera importante en la presentación de estas disfunciones pelvianas. Aún no existe evidencia probada de que el parto vaginal sea un factor completamente decisivo para la presencia de disfunciones del piso pélvico. Existe intensa investigación acerca del embarazo y el parto y sus efectos sobre el piso pélvico, y acerca de si algunas de las acciones obstétricas pueden ser modificadas con el fin de protegerlo de los potenciales daños.

The pelvic floor dysfunctions include urinary incontinence, pelvic organ prolapsed and anal incontinence. One in ten women will be subjected to surgery for pelvic floor dysfunction during their lifetime. In addition, between 30 percent and 50 percent will have a recurrence of these interventions. Motherhood is a factor that contributes significantly to the submission of pelvic dysfunctions. There is still no proven evidence that vaginal delivery is an absolutely crucial factor for the presence of pelvic floor dysfunction. There is extensive research on pregnancy and child birth and their effects on the pelvic floor and if some of the obstetric action scan be modified in order to protect it from potential damage.

Humans , Female , Pregnancy , Fecal Incontinence/etiology , Urinary Incontinence/etiology , Pregnancy Complications , Pelvic Organ Prolapse/etiology , Fissure in Ano/etiology , Obstetric Labor Complications , Pelvic Floor , Risk Factors
Rev. argent. coloproctología ; 22(4): 240-245, dic. 2011. ilus
Article in Spanish | LILACS | ID: lil-694441


Antecedentes: El tratamiento quirúrgico para las fistulas perianales ha sido tradicionalmente la fistulotomia o fistulectomia con o sin colocación de sedal, sin embargo, desde hace algunos años el LIFT resulta una alternativa terapéutica valida sobre todo porque no produce agresión alguna sobre el complejo esfínteriano ni invalida un ulterior procedimiento en caso de recidivas. Objetivo: Comunicar la experiencia inicial con LlFT para fístulas transesfínterianas. Pacientes y Métodos: Entre Octubre de 2010 y Junio de 2011 se realizaron 20 procedimientos LIFT en 20 pacientes (17 hombres y 3 mujeres); edades entre 18 y 70 años (43,4 media). Se realizo Ecografía endoanal de 360º preoperatoria en 12 pacientes (60%) y Resonancia Nuclear Magnética de alta resolución de Pelvis en 3 (15%). Todos los procedimientos se llevaron a cabo en pacientes con fístulas transesfintericas. Aquellos que no cumplían este requisito fueron tratados mediante otros procedimientos terapéuticos. Las variables evaluadas fueron: 1) Complicaciones intraoperatorias; 2) Morbilidad inmediata; 3) Estadía posoperatoria; 4) Tasa de recidiva durante el seguimiento; 5) tasa de incontinencia postquirúrgica. La mediana de seguimiento fue de 18.8 semanas (36-2). Resultados: Con respecto a complicaciones intraoperatorias hubo un sangrado que motivo la conversión a otro procedimiento (5%). Dos pacientes presentaron infección a nivel de la incisión interesfinterica (10%). Otro presento absceso en cabo esfinterico distal (5%). La retención aguda de orina no se tomo como complicación por lo que no se describe en este apartado. Ningún paciente presentaba antecedentes clínicos de jerarquía, excepto uno (el primero de la serie) que padecía diabetes insulino dependiente. Con respecto a antecedentes quirúrgicos, 5 pacientes (25%) habían sido íntervenidos previamente de patología fístular, que había recidivado. Los procedimientos realizados eran variables, pero en ningún caso LlFT... (TRUNCADO)

Background: The surgical treatment for perianal fistulas has traditionally been the fistulotomy, fistulectomy with or without seton colocation. However, since a few years the LlFT procedure is a valid therapeutic option mainly because it neither produces aggression on the sphincter complex non invalidates later procedure in case of recidivation. Objective: To communicate the initial experiences with LIFT procedure for transphincteric fistulas. Patients and Methods: Between October 2010 and June 2011 there have been twenty LlFT procedures with twenty patients (17 males and 3 females) which ages varied from 18 to 70 years (a media of 43,4). It was done a 360º endoanal ultrasound before surgery in 12 patients (60%) and Pelvis MRI in 3 (15%). All the procedures were done on patients with transphincteric fistulas. Those who didn't reach this requirement were treated trough other therapeutic procedures. The variables evaluated were: 1) Intraoperative complications; 2) Inmediate morbidity; 3) Postoperative staying; 4) Rates of recidivation during the follow-up; 5) Rates of postoperative incontinence. The median of follow­-up was of 18.8 weeks (36-2). Results: According to intraoperative complications there was a bleeding which led to another procedure (5%). Two patients had an infection in the intersphincteric incision (10%) and other presented an abscess in the distal sphincter cape (5%). The acute urinary retention it was not considered as a complication. For that reason it is not described in this report. None of the patients had clinic precedents, except one of them who were DBT insulin dependent. Regarding to surgical precedents, 5 patients (25%) had been previously operated of fistula-in-ano which had recidivated. The previous procedure which had been done were variable but in none case LIFT. Other previous surgical precedents were not documented. None of the patients had preoperative incontinence (it was used the wexner/Jorge incontinence scale)... (TRUNCADO)

Humans , Male , Adult , Female , Middle Aged , Anal Canal/surgery , Rectal Fistula/surgery , Ligation/methods , Rectal Diseases/surgery , Follow-Up Studies , Rectal Fistula/classification , Fecal Incontinence/etiology , Fecal Incontinence/prevention & control , Postoperative Complications
Femina ; 39(8): 387-393, ago. 2011. tab
Article in Portuguese | LILACS | ID: lil-613330


O câncer de colo uterino se apresenta como a segunda neoplasia maligna mais comum entre as mulheres no mundo. Seu tratamento consiste principalmente por histerectomia radical e dissecção dos linfonodos pélvicos, associada à quimioterapia e radioterapia nos estágios mais avançados da doença. Em consequência deste tratamento, podem aparecer as disfunções dos músculos do assoalho pélvico, principalmente por lesão nervosa. Contudo, objetivou-se, nesta revisão, identificar as disfunções do assoalho pélvico após o tratamento do câncer de colo uterino. Realizou-se revisão bibliográfica de estudos publicados de 2000 a 2010 nas bases de dados Medline, PubMed, PEDro, SciELO e Lilacs. Observou-se que sintomas urinários, intestinais e sexuais estão presentes após o tratamento do câncer de colo uterino. Dentre os sintomas urinários, estão presentes a incontinência urinária de esforço, a incontinência urinária mista, sintomas relacionados à hiperatividade da bexiga, ocorrendo a urgeincontinência, o aumento da frequência urinária, a noctúria e a urgência miccional. No que tange aos sintomas sexuais, pode-se observar que dispareunia, vaginismo, diminuição e/ou falta da lubrificação vaginal, excitação e orgasmo também ocorrem após o tratamento do câncer de colo uterino. Como sintomas intestinais, ocorreram a diarreia, a constipação e a incontinência anal. A fisioterapia sabidamente trata essas disfunções, fora do contexto do câncer de colo uterino, com elevadas taxas de sucesso e, por isso, o fisioterapeuta poderia auxiliar na reabilitação após o tratamento do câncer de colo uterino, se fosse inserido na equipe. Assim, torna-se cada vez mais importante a inclusão deste profissional nas equipes multidisciplinares

The cervical cancer appears as the second most common neoplasm malignancy among women worldwide. Its treatment consists mainly on radical hysterectomy and pelvic lymph node dissection, associated with chemotherapy and radiotherapy in advanced stages of the disease. As a result of this treatment, dysfunctions of the pelvic floor muscles, mainly for nerve injury, may appear. However, the purpose was to identify the pelvic floor dysfunctions after treatment of cervical cancer. We conducted a literature review of studies published from 2000 to 2010 in Medline, PubMed, PEDro, SciELO, and Lilacs. It was observed that urinary, bowel, and sexual symptoms are present after treatment of the cervical cancer. Among the urinary symptoms, the following are present: stress urinary incontinence, mixed urinary incontinence, symptoms of overactive bladder, urge-incontinence, increased urinary frequency, nocturia, and urgency. With respect to sexual symptoms, dyspareunia, vaginismus, reduced and/or lack of vaginal lubrication, arousal and orgasm also occur after treatment of cervical cancer. As intestinal symptoms, there were diarrhea, constipation, and anal incontinence. Physical therapy successfully treats these disorders, outside the context of the cervical cancer, with high success rates, and, therefore, the therapist could help in the rehabilitation after treatment of the cervical cancer, if he/she was inserted in the team. Thus, it becomes increasingly important to include this professional in multidisciplinary teams

Humans , Female , Sexual Dysfunction, Physiological/etiology , Sexual Dysfunction, Physiological/rehabilitation , Pelvic Floor Disorders/etiology , Pelvic Floor Disorders/rehabilitation , Uterine Cervical Neoplasms/complications , Physical Therapy Modalities , Pelvic Organ Prolapse/etiology , Pelvic Organ Prolapse/rehabilitation , Exercise Therapy/methods , Pelvic Floor/physiopathology , Fecal Incontinence/etiology , Urinary Incontinence/etiology
Clinics ; 66(12): 2007-2012, 2011. ilus, graf, tab
Article in English | LILACS | ID: lil-608994


OBJECTIVE: Perineal prostatectomy has been proposed as a less invasive and safe procedure, but the risk of anal incontinence has been studied. This study aimed to evaluate the effects of perineal access on anal continence mechanisms after perineal prostatectomy. METHODS: From August 2008 to May 2009, twenty three patients underwent perineal prostatectomy. These patients were evaluated before surgery and eight months postoperatively using the Cleveland Clinic Anal Incontinence Score, the Fecal Incontinence Quality of Life Score, and anorectal manometry. RESULTS: The mean age of the subjects was 65 (range, 54-72) years, and the mean prostate weight was 34.5 (range, 24-54) grams. Gleason scores ranged from 6-7, and the mean Cleveland Clinic Anal Incontinence Score (mean±;standard deviation) values were 0.9±1.9 and 0.7±1.2 (p.0.05) before and after surgery, respectively. The Fecal Incontinence Quality of Life Score did not change significantly after surgery. The mean values for anal manometric parameters before and after surgery were, respectively: Resting Pressures of 64±23 mmHg and 65±17 mmHg (p = 0.763), Maximum Squeezing Pressures of 130±41 mmHg and 117±40 mmHg (p = 0.259), High Pressure Zones of 3.0±0.9 cm and 2.7±0.8 cm(p = 0.398), Rectal Sensory Thresholds of 76±25 mland71±35 ml (p = 0.539), Maximum Tolerated Rectal Volumes of 157±48 ml and 156±56ml (p = 0.836), and Sphincter Asymmetry Indexes 22.4±9 percent and 14.4±5 percent (p = 0.003). CONCLUSION: There was a significant decrease in the sphincter symmetry index after perineal prostatectomy. With the exception of the sphincter asymmetry index, perineal prostatectomy did not affect anal continence parameters.

Aged , Humans , Male , Middle Aged , Fecal Incontinence/etiology , Perineum/surgery , Prostatectomy/methods , Prostatic Neoplasms/surgery , Manometry , Prospective Studies , Prostatectomy/adverse effects , Quality of Life
Acta cir. bras ; 24(5): 416-422, Sept.-Oct. 2009. ilus, graf, tab
Article in English | LILACS | ID: lil-529163


PURPOSE: To evaluate fecal continence, anorectal manometry (AM) and profilometry (P), in patients operated for congenital megacolon, using either the modified Duhamel technique (MDT) or the modified transanal rectosigmoidectomy (MTR) technique. METHODS: 42 patients were evaluated clinically and via AM and P, for postoperative control. The resting, coughing, voluntary contraction, maintained voluntary contraction and perianal stimulation pressures were investigated. The rectosphincteric reflex was tested and the simple and enhanced pressure curves were evaluated. The three-dimensional profilometric outline was produced. Student's t, chi-squared and Fisher's exact tests were used for statistical analysis (p<0.05). RESULTS: AM showed mean resting pressures of 53.44 mmHg for MDT and 60.67 mmHg for MTR, and mean voluntary contraction pressures of 94.50 mmHg for MDT and 95.47 mmHg for MTR. There was no statistical difference between the groups. The shapes of the simple and enhanced pressure curves did not present any statistical difference, independent of the surgical technique used. CONCLUSION: The two surgical techniques were equivalent. MDT caused greater incidence of postoperative constipation that MTR did. AM and P were shown to be excellent tests for postoperative follow-up among these patients.

OBJETIVO: Avaliar a continência fecal, a manometria anorretal (MAR) e a profilometria (PFM), em pacientes submetidos a tratamento cirúrgico do megacolo congênito pelas técnicas de Duhamel modificado (DM) ou de retossigmoidectomia transanal modificada (RTM). MÉTODOS: 42 pacientes foram clinicamente avaliados e submetidos à MAR e PFM para controle pós-operatório. Foram pesquisadas as pressões no repouso (PR), à tosse (T), à contração voluntária (CV), à contração voluntária mantida (CVM) e à estimulação perianal (EPA). O reflexo reto-esficteriano (RRE) foi testado e as curvas pressóricas simples e potencializada foram avaliadas. Foi elaborado traçado tridimensional de PFM. Utilizamos os testes t de Student, Qui-Quadrado e exato de Fisher para análise estatística (p<0,05). RESULTADOS: A MAR mostrou médias de PR=53,44 mmHg para DM e 60,67 mmHg para RTM; CV média = 94,50 mmHg para o grupo DM e 95,47 mmHg para o grupo RTM. Não houve diferença estatística entre os grupos. A forma das CPS e CPP não apresentou diferença estatística, independentemente da técnica cirúrgica utilizada CONCLUSÃO: As duas técnicas operatórias foram manometricamente equivalentes. DM determinou maior incidência de constipação pós-operatória que RTM. A MAR e a PFM revelaram-se excelentes exames para acompanhamento destes pacientes após a cirurgia.

Adolescent , Child , Child, Preschool , Female , Humans , Infant , Male , Anal Canal/surgery , Constipation/prevention & control , Fecal Incontinence/etiology , Hirschsprung Disease/surgery , Rectum/surgery , Anal Canal/anatomy & histology , Anal Canal/physiology , Constipation/etiology , Digestive System Surgical Procedures/methods , Fecal Incontinence/physiopathology , Manometry , Postoperative Care , Postoperative Complications , Pressure , Rectum/physiology , Treatment Outcome