Document Detail


Temperature-controlled radiofrequency energy (SECCA) to the anal canal for the treatment of faecal incontinence offers moderate improvement.
MedLine Citation:
PMID:  17556904     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND AND AIM: Faecal incontinence is a devastating complaint. Even after conservative treatment, many patients still remain incontinent. Few patients have a sphincter defect suitable for repair. Other emerging surgical therapies like dynamic gracilis plasty, neuromodulation or artificial bowel sphincter, carry side effects and show only moderate improvement. Temperature-controlled radiofrequency energy (SECCA) has shown promising results in the USA. Local tightening seems to be the mode of action with possible increased rectal sensitivity. We investigated the effectiveness of radiofrequency and possible changes in the anal sphincter with 3D-ultrasound in patients with faecal incontinence. PATIENTS AND METHODS: Eleven women, mean age 61 years (49-73) with long-standing faecal incontinence were included. Patients with large sphincter defects and anal stenosis were excluded. The SECCA procedure was performed under conscious sedation and local anaesthesia. Oral antibiotics were given. In four quadrants on four or five levels (depending upon length of the anus) radiofrequency was delivered with multiple needle electrodes. Patients were evaluated at 0, 6 weeks, 3 and 6 months and 1 year. Three-dimensional anal ultrasound was performed at 0 (before and after the procedure), 6 weeks and 3 months. Anal manometry and rectal compliance measurement were performed at 0 and 3 months. RESULTS: At 3 months, six of 11 patients improved, which persisted during follow-up of 1 year. The Vaizey score changed from 18.8 to 15.0 (P=0.03) and in those improved from 18.3 to 11.5 (P=0.03). Anal manometry and rectal compliance showed no significant changes, there was a tendency to increased rectal sensitivity concerning urge and maximal tolerated volume (both P=0.3). Responders compared with nonresponders showed no difference in test results. Side effects were local haematoma (2), bleeding 3 days (1), pain persisting 1-3 weeks (4) and laxatives-related diarrhoea during 1-3 weeks (4). CONCLUSION: The SECCA procedure seems to be promising for patients with faecal incontinence with a persisting effect after 1 year. No significant changes in tests were found.
Authors:
Richelle J Felt-Bersma; Maria M Szojda; Chris J Mulder
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Publication Detail:
Type:  Evaluation Studies; Journal Article    
Journal Detail:
Title:  European journal of gastroenterology & hepatology     Volume:  19     ISSN:  0954-691X     ISO Abbreviation:  Eur J Gastroenterol Hepatol     Publication Date:  2007 Jul 
Date Detail:
Created Date:  2007-06-08     Completed Date:  2007-09-04     Revised Date:  2009-10-16    
Medline Journal Info:
Nlm Unique ID:  9000874     Medline TA:  Eur J Gastroenterol Hepatol     Country:  England    
Other Details:
Languages:  eng     Pagination:  575-80     Citation Subset:  IM    
Affiliation:
Department of Gastroenterology and Hepatology, VU University Medical Centre, Amsterdam, The Netherlands. rjf.felt@vumc.nl
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MeSH Terms
Descriptor/Qualifier:
Aged
Anal Canal / physiopathology,  radiation effects*,  ultrasonography
Compliance / radiation effects
Fecal Incontinence / physiopathology,  radiotherapy*,  ultrasonography
Female
Humans
Imaging, Three-Dimensional
Manometry
Middle Aged
Pilot Projects
Prospective Studies
Radio Waves / adverse effects,  therapeutic use*
Rectum / physiopathology,  radiation effects
Severity of Illness Index
Temperature
Treatment Outcome

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


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