Home About us Contact
|
Home About us Contact | ||
|
|
||
Continence Score (continence + score)
Selected AbstractsLong-term effects of stapled haemorrhoidectomy on internal anal function and sensitivity,BRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 11 2001Dr D. F. Altomare Background: Stapled haemorrhoidectomy is gaining wide acceptance but there is still some concern about the risk of injury to the internal anal sphincter (IAS). IAS function and morphology, and anal canal sensitivity were studied prospectively in patients undergoing this operation. Methods: Twenty patients (11 women; mean age 43 years) with stage III haemorrhoids entered the study. All underwent preoperative anorectal manometry, rectoanal inhibitory reflex (RAIR) testing and three-dimensional transanal ultrasonography. A test of anal sensation was administered to evaluate ability to discriminate between air and warm water. All the investigations were repeated 6 months after the operation. Results: The mean(s.d.) maximal resting pressure was 87(30) mmHg before surgery and 81(20) mmHg afterwards (P not significant). The maximal squeeze pressure did not change after operation (178(43) versus 174(60) mmHg). The RAIR showed the same features in 19 of 20 patients before and 18 of 20 after operation. Three-dimensional ultrasonography demonstrated no changes in the width of the IAS (mean(s.d.) 2·1(4) mm before and 2·1(3) mm after surgery). The ability of the anal mucosa to discriminate air from warm water improved in five patients. Continence scores did not differ significantly after 6 months. Conclusion: Stapled haemorrhoidectomy does not affect the function and morphology of the IAS in the long term. The sensitivity of the anal canal can improve in patients with preoperative sensory impairment. © 2001 British Journal of Surgery Society Ltd [source] Faecal incontinence after lateral internal sphincterotomy is often associated with coexisting occult sphincter defects: A study using endoanal ultrasonographyANZ JOURNAL OF SURGERY, Issue 10 2001Joe J. Tjandra Background: Troublesome faecal incontinence following a lateral internal sphincterotomy (LIS) is often attributed to faulty surgical techniques: division of excessive amount of internal sphincter or inadvertent injury to the external sphincter. The aim of the present paper was to assess the anatomic and physiological factors that may contribute to faecal incontinence following a technically satisfactory lateral internal sphincterotomy by a group of colorectal specialists. Methods: Fourteen patients (nine women, five men; median age: 38 years; range: 23,52 years) who developed troublesome postoperative faecal incontinence were evaluated by clinical assessment, endoanal ultrasonography and anorectal physiological studies (manometry, pudendal nerve terminal motor latency) by two independent observers. The Cleveland Clinic continence score (0,20; 0, perfect continence; 20, complete incontinence) was used to quantify the severity of faecal incontinence. Fourteen continent subjects after a LIS (nine female patients, five male patients; median age: 36 years; range: 20,44 years) were also evaluated as ,continent' controls (continence score , 4). Results: In the incontinent group, the median postoperative Cleveland Clinic continence score was 9 (range: 6,13) compared with a preoperative score of 1 (range: 0,3). On assessment by endoanal ultrasonography the site of the internal sphincterotomy was clearly identified. There were additional coexisting defects, on endoanal ultrasonography, of the external anal sphincter in seven female patients, of the internal sphincter in two female and two male patients; and a defect of both the external and internal sphincters in a male patient who had had a prior fistulotomy. The pudendal nerve terminal motor latency (PNTML) was prolonged in two female patients on the side contralateral to the lateral internal sphincterotomy. In two of five male patients there was no evidence of any occult sphincter injuries. In the continent controls a defect of the distal portion of the external sphincter was noted in one female patient. None of the patients had a prolonged PNTML. The maximum voluntary contraction was significantly lower in the female subjects than in the female continent controls (92 mmHg vs 140 mmHg; P < 0.05), while the resting anal canal pressures and length of the high pressure zone were similar between the study subjects and the continent controls. Conclusion: Troublesome faecal incontinence after a satisfactorily performed lateral internal sphincterotomy is often associated with coexisting occult sphincter defects. [source] Recent impact of anal sphincter injury on overall Caesarean section incidenceAUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 3 2006Rhona MAHONY Abstract Introduction:, Because of increasing recognition of obstetric anal sphincter injury and faecal incontinence, we examined the recent impact of these indications on our institutional Caesarean section incidence. Methods:, Retrospective review of the indications for multiparous Caesarean section was performed at the National Maternity Hospital for the 4 years 2000,2003, inclusive, to identify women in whom previous anal sphincter injury was an indication. Individual charts were reviewed and data regarding the nature and extent of previous anal sphincter injury were obtained. Results:, Among 17 586 consecutive multiparous deliveries, previous anal sphincter trauma constituted the indication for Caesarean delivery in 67 women, representing 0.4% of all multiparae, 2.9% of multiparous Caesarean sections and 1.3% of all Caesarean sections performed. Fifty (85%) of the 67 women who opted for prelabour Caesarean delivery following previous obstetric anal sphincter injury had symptoms of faecal incontinence (mean continence score 5, range 1,17). Conclusion:, Notwithstanding recent increased awareness and documentation, anal sphincter problems represent a small influence on total Caesarean incidence. [source] A pilot study of ultrasound guided Durasphere injection in the treatment of faecal incontinenceCOLORECTAL DISEASE, Issue 9 2010A. D. Beggs Abstract Aim, To assess injection of Durasphere under direct endoanal ultrasound guidance as a treatment for faecal incontinence. Method, A total of 23 patients with varying degrees of persistent faecal leakage and/or soiling were recruited. Durasphere was injected in the intersphincteric plane under direct ultrasound guidance. All patients were given a general anaesthetic. Patients had ano-rectal physiology, endoanal ultrasound, continence scoring and quality of life measures assessed at 0, 1, 3, 6 and 12 months. Results, A total of 21 patients were followed up for at least 12 months, with two being excluded at the follow-up stage. Friedman two-way analysis of variance of the Cleveland Clinic Score, Faecal Incontinence Quality of Life Score and Diary Response Score demonstrated a significant sustained improvement. There was no significant improvement in number of bowel movements. There was a significant difference in anal squeeze pressure after therapy, but no significant difference in anal resting pressure. Six patients reported no improvement after Durasphere therapy. Conclusions, Durasphere gave sustained improvements in quality of life and continence scores in this study group. Strict criteria are needed to ascertain suitability for Durasphere therapy. [source] | ||||||||||