Can We Predict the Severity of Fecal Incontinence by Preoperative Physiologic

ABSTRACT

Many kinds of different treatment options for fecal incontinence such as biofeedback therapy, anterior or posterior sphincteroplasty, pelvic floor repair, gracilis or gluteus muscle transposition have been introduced. However, appropriate indications for these treatment options have not yet been delineated up to now. PURPOSE: The aim of this study was to access the preoperative severity of fecal incontinence by physiologic tests to give an idea that indications of appropriate selection criteria and parameters for assess the outcome could be simultaneously considered by preoperatively objective physiologic data. MATERIALS AND METHODS: From January 3, 1997 to, August 1, 1997 all patients with fecal incontinence who visited colorectal clinic in the Department of Surgery, Korea Veterans Hospital, were classified into two groups according to the severity of fecal incontinence (0~20) Group I (1~9), Group II (10~20) and compared them with the results of physiologic tests anorectal manometry, endorectal ultrasound (ERU), cinedefecography, and pudendal nerve terminal motor latency (PNTML). Statistical analysis was performed by Student's-t test, and Chi-square test and p<0.05 was considered significant. RESULTS: The number of GI was 25, and GII was 22. There were no differences between the two groups in terms of age (GI 57.7+/-14.5, GII 61.4+/-14.0years), gender (male female, 196, 166), cause (neurogenic; 11/25 (GI),7/22(GII), postanal surgery; 6/25,6/22) obstetric trauma (2/25, 2/22), anal trauma (1/25, 1/22) diabetes melitus (1/25, 2/22), rectal prolapse (2/25, 1/22), and others (2/25, 3/22), duration of fecal incontinence (64.4+/-82.2, 48.7+/-65.3 months), high pressure zone (3.3+/-1.7, 3.5+/-1.4 cm), mean resting pressure (50.5+/-27.0, 51.9+/-18.7 cm H2O), maximal resting pressure (88.4+/-50.6, 89.4+/-41.8 cm), maximal squeezing pressure (150.6+/-71.0, 129.7+/-59.5 cm H2O), rectoanal inhibitatory reflex (13/21, 8/21 positive), sensitivity (37.5+/-15.2, 41.8+/-29.0 cc), compliance (19.0+/-14.5, 21.4+/-39.4 cc/cm H2O) in anorectal manometric findings, anal sphincter defect (13/21, 15/22 positive), size of defect (60+/-26.30degrees, 71 +/-30.8degrees/360degrees), thickness of the external anal sphincter (3.46+/-0.78, 3.84 +/-1.02 cm), thickness of internal anal sphincter (1.58+/-0.79, 1.74+/-0.81 cm) in ERU, anorectal angle in rest (85.2+/-28.0degrees, 97+/-22.9degrees), squeeze (72+/-27.1degrees, 82 +/-19.7degrees), push (100+/-43.9degrees, 117.9+/-34.5degrees), length of perineal descent in rest (3.7+/-1.2, 3.6+/-1.7 cm), squeeze (2.9+/-1.5, 2.7+/-1.5 cm), push (7.9+/-3.5, 6.6+/-2.6 cm) in cinedefecography. However, rectal capacity in manometry (212.5+/-99.9, 155+/-51.5 cc, p<0.05), right PNTML (1.73+/-0.39, 2.71+/-0.83 ms, p<0.001), and left PNTML (1.83+/-0.43, 2.94+/-0.80 ms, p<0.001) were significantly increased in GII compare to those of GI. CONCLUSION: As the severity of fecal incontinence was increased, rectal capacity, right and, left PNTML were increased.