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Physiological changes after postanal repair and parameters predicting outcome.

K Yoshioka1, G Hyland, M R Keighley

  • 1Department of Surgery, General Hospital, Birmingham, UK.

The British Journal of Surgery
|December 1, 1988
PubMed
Summary
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Postanal repair did not improve physiological parameters in patients with fecal incontinence. Pre-operative low anal pressures and pelvic floor descent identified patients unlikely to benefit from this surgical intervention.

Area of Science:

  • Colorectal Surgery
  • Physiology
  • Gastroenterology

Background:

  • Fecal incontinence is a debilitating condition affecting quality of life.
  • Postanal repair is a surgical option, but its efficacy and predictive factors for success require further investigation.

Purpose of the Study:

  • To evaluate the physiological changes after postanal repair in patients with fecal incontinence.
  • To identify pre-operative predictors of successful surgical outcomes.

Main Methods:

  • Nineteen patients undergoing postanal repair were assessed pre- and post-operatively.
  • Physiological parameters (anal pressures, saline infusion volumes) and videoproctography were compared to 16 controls.
  • Pre-operative data were analyzed to identify predictors of improvement.

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Main Results:

  • Postanal repair did not significantly improve resting, squeeze, or strain anal pressures, nor saline infusion volumes.
  • Videoproctography revealed persistent pelvic floor and perineal descent, and short anal canal length post-surgery.
  • Pre-operative low anal pressures and significant pelvic floor/perineal descent predicted poor surgical outcomes.

Conclusions:

  • Postanal repair does not appear to restore normal anorectal physiology in patients with fecal incontinence.
  • Pre-operative assessment of anal pressures and pelvic floor dynamics can identify patients unlikely to benefit from this procedure.