ABSTRACT
BACKGROUND: The aim of this prospective study was to determine the efficiency of the Gore Bio-A synthetic plug in the treatment of anal fistulas. METHODS: A synthetic bioabsorbable anal fistula plug was implanted in 60 patients. All fistulas were transsphincteric and cryptoglandular in origin. RESULTS: The healing rate after 1 year of follow-up was 52 % (31 out of 60 patients). No patient was lost to follow-up. The treatment had no effect on the incontinence score. The plug dislodgement rate was 10 % (6 out of 60 patients). Thirty-four per cent of the patients (16 out of 47) required reoperation. The average operating time was 32 ± 10.2 min, and the average length of hospital stay was 3.3 ± 1.8 days. CONCLUSIONS: Synthetic plugs may be an alternative to bioprosthetic fistula plugs in the treatment of transsphincteric anal fistulas. This method might have better success rates than treatment with bioprosthetic fistula plugs.
Subject(s)
Absorbable Implants , Cutaneous Fistula/surgery , Prosthesis Implantation , Rectal Fistula/surgery , Adult , Dioxanes , Female , Follow-Up Studies , Humans , Length of Stay , Male , Middle Aged , Operative Time , Polyglycolic Acid , Prospective Studies , Prosthesis Failure , Reoperation , Treatment Outcome , Wound HealingABSTRACT
BACKGROUND: The evidence for conservative treatment of anal incontinence is poor. In our first publication [Schwandner et al. Dis Colon Rectum 2010; 53: 1007-1016] we demonstrated that a novel therapeutic concept, termed triple target treatment (3T), combining amplitude-modulated medium frequency stimulation and electromyography biofeedback (EMG-BF) was superior to EMG-BF alone. Questions about the required treatment duration and the relevant subgroups of patients with sphincter damage and damaged anal sensibility were not addressed. METHODS: We enrolled 158 patients with anal incontinence in this randomized study. Here, we -report on the important subgroup analyses of patients with and without sphincter damage and damaged anal sensibility for the endpoints Cleveland Clinic Score (CCS) and success record. Using the results of this study we propose a novel treatment algorithm which is open for discussion. RESULTS: In patients with sphincter damage, the median difference on the CCS from baseline to 9 months was 5 points higher for 3T than for EMG-BF (95 % confidence interval 0-8; p = 0.0168). While 47 % of the patients with sphincter damage became continent with 3T, only 18 % did with EMG-BF (p = 0.0036). Ten of 17 patients in the 3T group regained anal sensibility after 3 months stimulation. There was tendency towards improved continence in patients with neuropathy upon 3T treatment (p = 0.1219). CONCLUSIONS: 3T is superior to EMG-BF alone for patients with sphincter damage and neuropathic anal incontinence. It is a successful key element within our treatment algorithm, even in patients with sphincter damage and neuropathic anal incontinence.
Subject(s)
Algorithms , Biofeedback, Psychology/methods , Electric Stimulation Therapy/methods , Electromyography/methods , Evidence-Based Medicine , Fecal Incontinence/therapy , Fecal Incontinence/etiology , Female , Follow-Up Studies , Humans , Male , Patient Satisfaction , Treatment OutcomeABSTRACT
BACKGROUND AND OBJECTIVE: The severity of fecal incontinence is usually assessed in grades based on medical history. However, this grading does not consider stool frequency and thus the impairment suffered by the patients. A German translation of the incontinence scores of the Cleveland Clinic (CCS) for a standardized measurement disability has been recommended but not yet tested. Similarly, the impact of fecal incontinence on quality of life needs to be assessed with a specific assessment. The Fecal Incontinence Quality of Life Scale (FIQoL) is available for this, but not yet a German-language version. PATIENTS AND METHODS: For the German version of the CCS and the FIQoL we first evaluated linguistic aspects via translation and back-translation. We then compared the response to the translated questionnaires of a sample of 158 German patients who had fecal incontinence with those reported in English-language publications. RESULTS: The German versions were judged to be successful. The comparison with six published studies showed similar scores in the CCS and in all subscales of the FIQoL. CONCLUSION: Satisfactory German-language questionnaires are now available to assess the severity of fecal incontinence and specific aspects of the quality of life.
