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Pelvic floor procedures produce no consistent changes in anatomy or physiology
1Department of Surgery, Lukas-Andreas Hospital, Amsterdam, The Netherlands.
Diseases of the Colon and Rectum
|March 26, 1998
Summary
Pelvic floor repair surgery for neurogenic fecal incontinence showed limited improvement in continence. The study suggests clinical gains may stem from placebo effects or stenosis, not enhanced muscle function.
Area of Science:
- Colorectal Surgery
- Pelvic Floor Disorders
- Neurogenic Incontinence
Background:
- Postanal repair aims to improve anal canal anatomy and function in neurogenic fecal incontinence.
- Current surgical outcomes show improvement in less than 50% of patients.
- Total pelvic floor repair (anterior levatorplasty and sphincter plication) is proposed to enhance functional results.
Purpose of the Study:
- To compare the efficacy of postanal repair versus total pelvic floor repair in patients with neurogenic fecal incontinence.
- To evaluate the impact of these surgical interventions on anal canal anatomy and function.
Main Methods:
- A randomized trial involving twenty female patients with Type D incontinence.
- Assessment included anal manometry, defecography, and continence grading at 12 weeks post-surgery.
- Statistical analysis employed Wilcoxon's signed-rank and two-sample tests.
Main Results:
- Continence improved in eight (40%) of the twenty patients studied.
- No statistically significant differences were observed in clinical, manometric, or radiologic parameters between the surgical groups.
- The study did not demonstrate consistent anatomical or physiological changes post-surgery.
Conclusions:
- Pelvic floor repair procedures do not consistently alter anal canal anatomy or physiology.
- Observed clinical improvements in fecal incontinence may be attributed to local stenosis or placebo effects.
- These surgical interventions do not appear to enhance underlying muscle function for neurogenic fecal incontinence.