Document Detail


Anal manometric parameters: predictors of outcome following anal sphincter repair?
MedLine Citation:
PMID:  15623452     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Controversy exists over the utility of manometry in the management of fecal incontinence. In light of newer methods for the management of fecal incontinence demonstrating favorable results, this study was designed to evaluate manometric parameters relative to functional outcome following overlapping sphincteroplasty. Twenty women, 29 to 84 years of age (mean age 50 years), with severe fecal incontinence and large (>or=50%) sphincter defects on ultrasound were studied. All participants underwent anal manometry (mean resting pressure, mean squeeze pressure, anal canal length, compliance), pudendal nerve terminal motor latency (PNTML) testing, and completed the American Society of Colon and Rectal Surgeons fecal incontinence severity index (FISI) survey before and 6 weeks after sphincter repair. Statistical analysis for all data included the Wilcoxon rank-sum test, Mann-Whitney test, and Spearman's correlation. Significant perioperative improvement was seen in the absolute resting and squeeze pressures and anal canal length. Overlapping sphincteroplasty was also associated with significant improvement in fecal incontinence scores (FISI 36 vs. 16.4; P=0.0001). Although no single preoperative manometric parameter was able to predict outcome following sphincteroplasty, preoperative mean resting and squeeze pressures as well as anal canal length inversely correlated with the relative changes in these parameters achieved postoperatively. These findings suggest that either the physiologic parameters studied are not predictive of functional outcome or the scoring system used is ineffective in determining function. The perioperative paradoxical changes in resting pressure, squeeze pressure, and anal canal length would support the use of overlapping sphincteroplasty in patients with significant sphincter defects and poor anal tone.
Authors:
Susan Gearhart; Tracy Hull; Crina Floruta; Tom Schroeder; Jeff Hammel
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract     Volume:  9     ISSN:  1091-255X     ISO Abbreviation:  J. Gastrointest. Surg.     Publication Date:  2005 Jan 
Date Detail:
Created Date:  2004-12-29     Completed Date:  2005-06-15     Revised Date:  2005-11-17    
Medline Journal Info:
Nlm Unique ID:  9706084     Medline TA:  J Gastrointest Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  115-20     Citation Subset:  IM    
Affiliation:
Department of Colorectal Surgery, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Aged, 80 and over
Anal Canal / physiopathology*,  surgery*
Fecal Incontinence / diagnosis,  physiopathology,  surgery*
Female
Humans
Manometry
Middle Aged
Prospective Studies
Treatment Outcome

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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