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Perineal antropylorus transposition for end-stage fecal incontinence in humans: initial outcomes.
MedLine Citation:
PMID:  23392152     Owner:  NLM     Status:  In-Data-Review    
BACKGROUND: : Technical feasibility of perineal antropyloric valve transposition to reconstruct a severely damaged incontinent anal sphincter or to replace an excised anorectal sphincter has been reported previously.
OBJECTIVE: : This study aimed to document the follow-up results of patients who underwent successful perineal antropyloric valve transposition for end-stage fecal incontinence.
SETTING: : This study was conducted at a single tertiary care institution.
PATIENTS: : Seventeen patients underwent the procedure. Eight patients had replacement (group 1) and 9 patients had augmentation (group 2) of the anal sphincter. Two patients in group 1 with early graft-related complications were excluded from further analysis, because they had the grafts excised.
MAIN OUTCOME MEASURES: : The primary outcome measures were anatomical integrity and functional status of the graft in the perineum, fecal incontinence scores, and quality-of-life scores (SF-36) over a median follow-up of 18 months.
RESULTS: : The transposed grafts had a definite tone on digital examination, were well visualized on perineal MRI, showed high-velocity vascular inflow on Doppler ultrasound study, and good vascularity on celiac CT angiography. Anal manometry showed a significant (p = 0.03) rise in the postoperative resting neosphincter pressures with good retention of barium proximal to pyloric valve on distal loopogram. The postoperative St Mark incontinence score improved in both groups and was significantly better in group 2 than in group 1. There was significant improvement in postoperative physical and mental component scores in both groups with higher scores in group 2 than in group 1 on follow-up.
LIMITATIONS: : A longer follow-up with a larger sample size is required.
CONCLUSIONS: : Antropyloric valve transposition can be used effectively for a selected group of patients with end-stage fecal incontinence. Patients undergoing anal sphincter augmentation have better outcomes in comparison with those having an excised sensate anorectum.
Abhijit Chandra; Ashok Kumar; M Noushif; Vishal Gupta; Devendra Singh; Manoj Kumar; R N Srivastava; U C Ghoshal
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Diseases of the colon and rectum     Volume:  56     ISSN:  1530-0358     ISO Abbreviation:  Dis. Colon Rectum     Publication Date:  2013 Mar 
Date Detail:
Created Date:  2013-02-08     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0372764     Medline TA:  Dis Colon Rectum     Country:  United States    
Other Details:
Languages:  eng     Pagination:  360-6     Citation Subset:  IM    
1 Department of Surgical Gastroenterology, King George's Medical University, Lucknow, India 2 General Surgery, King George's Medical University, Lucknow, India 3 Radiodiagnosis, King George's Medical University, Lucknow, India 4 Orthopaedics, King George's Medical University, Lucknow, India 5 Department of Gastroenterology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India.
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