Document Detail

Impact of two different types of anal retractor on fecal continence after fistula repair: a prospective, randomized, clinical trial.
MedLine Citation:
PMID:  14668594     Owner:  NLM     Status:  MEDLINE    
PURPOSE: This study was designed to compare two different types of anal retractors (Parks vs. Scott) with regard to their impact on fecal continence after fistula repair. METHODS: Between November 2000 and November 2001, 30 patients were randomized into two groups. In Group A (n = 15), a Parks retractor was used during fistula repair, whereas in Group B (n = 15), the repair was performed with a Scott retractor. Before and three months after surgery, maximum anal resting pressure and maximum anal squeeze pressure were recorded. In addition, continence status was evaluated using both the Rockwood Fecal Incontinence Severity Index and the scoring system according to Parks. RESULTS: In Group A, the median anal resting pressure dropped from 76 mmHg to 42 mmHg. In Group B, no significant difference was observed between the preoperative and postoperative anal resting pressure. The difference in the changes from baseline between the two groups was statistically significant (P = 0.035). No significant changes in anal squeeze pressure were observed. In Group A, the median Rockwood fecal incontinence score increased from 0 to 12. In Group B, the median Rockwood fecal incontinence score did not change after the operation. The difference between the two groups was statistically significant (P = 0.038). CONCLUSIONS: The use of a Parks retractor during perianal fistula repair has a deteriorating effect on fecal continence, probably because of damage to the internal anal sphincter. Because this side effect was not observed after the use of a Scott retractor, we advocate the use of this retractor during all fistula repairs.
David D E Zimmerman; Martijn P Gosselink; Willem C J Hop; Muriel Darby; John W Briel; W Rudolf Schouten
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Publication Detail:
Type:  Clinical Trial; Journal Article; Randomized Controlled Trial    
Journal Detail:
Title:  Diseases of the colon and rectum     Volume:  46     ISSN:  0012-3706     ISO Abbreviation:  Dis. Colon Rectum     Publication Date:  2003 Dec 
Date Detail:
Created Date:  2003-12-11     Completed Date:  2004-01-06     Revised Date:  2005-11-17    
Medline Journal Info:
Nlm Unique ID:  0372764     Medline TA:  Dis Colon Rectum     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1674-9     Citation Subset:  IM    
Department of Surgery, Colorectal Research Group, Erasmus Medical Center, Rotterdam, the Netherlands.
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MeSH Terms
Anal Canal / pathology,  surgery*
Equipment Design
Fecal Incontinence / etiology*
Middle Aged
Postoperative Complications*
Prospective Studies
Rectal Fistula / surgery*
Surgical Instruments / adverse effects*

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

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