Annals of Coloproctology

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Original Article

Anorectal benign disease

Long-term outcomes of intramural rectal botulinum toxin injections for urge fecal incontinence: a salvage therapy for sacral neuromodulation nonresponders?: Philippe Onana Ndong, Véronique Vitton; Ann Coloproctol. 2025;41(5):417-423. Published online October 23, 2025; DOI: https://doi.org/10.3393/ac.2025.00332.0047

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Graphical Abstract Abstract PDF: Purpose
Sacral neuromodulation (SNM) failure in fecal incontinence (FI) management represents a therapeutic challenge, often leading to more invasive, less accepted alternatives with inconsistent efficacy. In this context, intramural rectal botulinum toxin A (BoNT-A) injection has recently emerged as a promising minimally invasive alternative for urge FI. This study aimed to evaluate the effectiveness of intramural rectal BoNT-A injections in the challenging subgroup of SNM nonresponders.
Methods
This retrospective, single-center study included patients with urge FI who underwent intramural rectal BoNT-A injections after SNM failure, between February 2018 and September 2024. The procedure involved endoscopic injection of 200 units of BoNT-A at 10 circumferential sites in the rectal wall. Treatment efficacy was assessed using the Cleveland Clinic Fecal Incontinence Score (CCFIS) and a visual analog scale (VAS) for symptom severity.
Results
Fifteen female patients met the inclusion criteria, with a median follow-up of 22.5 months (range, 4.4–103.2 months). Patients received a median of 2 injections, with a median reinjection interval of 9.8 months. CCFIS scores demonstrated significant improvement (median, 15 [range, 8–20] vs. 8 [range, 0–20]; P=0.001), as did VAS symptom scores (median, 4 [range, 0–5] vs. 2 [range, 0–5]; P=0.001). No adverse events were reported.
Conclusion
This study provides long-term evidence supporting intramural rectal BoNT-A injections as an effective option for managing urge FI, including as salvage therapy in SNM nonresponders. Further studies are necessary to confirm these findings and define the optimal role of BoNT-A within the therapeutic algorithm for urge FI.

Review

Anorectal benign disease

Pharmacotherapy for fecal incontinence: potential treatment with a traditional Japanese medicine Kampo: Kotaro Maeda, Toshinobu Sasaki, Tomohisa Hattori; Ann Coloproctol. 2025;41(5):369-378. Published online October 23, 2025; DOI: https://doi.org/10.3393/ac.2025.00283.0040

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Abstract PDF: Fecal incontinence (FI) significantly impairs patient quality of life and creates substantial distress not only for affected individuals but also for nurses and caregivers. The prevalence of FI among older adults is estimated at up to 20%, although the sensitive nature of the condition often prevents active reporting by patients. This article reviews risk factors and pharmacotherapies for FI, emphasizing the therapeutic potential of Daikenchuto (DKT). The etiology of FI is multifactorial and lacks a singular definition. Currently, no prescription drugs specifically approved for FI are available, leaving treatment options limited. Nonetheless, major clinical guidelines have identified several viable pharmacological approaches. Strongly recommended treatments include the antidiarrheal agent loperamide and stool bulking or solidifying agents, such as dietary fiber and polycarbophil. Other therapeutic options include ramosetron, a 5-HT3 receptor antagonist; amitriptyline, a tricyclic antidepressant; and sodium valproate and diazepam, which are GABAergic neuromodulators. Recently, research has explored the efficacy and mechanism of action of DKT, a traditional Japanese medicine Kampo. Historically used for abdominal symptoms like bloating and known for promoting intestinal motility, emerging evidence suggests DKT may also effectively manage FI.

Original Article

Anorectal benign disease

Long-term outcomes of sacral neuromodulation for low anterior resection syndrome after rectal cancer surgery: Mario J. de Miguel Valencia, Gabriel Marin, Ana Acevedo, Ana Hernando, Alfonso Álvarez, Fabiola Oteiza, Mario J. de Miguel Velasco; Ann Coloproctol. 2024;40(3):234-244. Published online June 25, 2024; DOI: https://doi.org/10.3393/ac.2023.00542.0077

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Abstract PDF

Purpose
This study assessed the long-term outcomes and quality of life in patients who underwent sacral neuromodulation (SNM) due to low anterior resection syndrome (LARS).
Methods
This single-center retrospective study, conducted from 2005 to 2021, included 30 patients (21 men; median age, 70 years) who had undergone total mesorectal excision with stoma closure and had no recurrence at inclusion. All patients were diagnosed with LARS refractory to conservative treatment. We evaluated clinical and quality-of-life outcomes after SNM through a stool diary, Wexner score, LARS score, the Fecal Incontinence Quality of Life (FIQL) questionnaire, and EuroQol-5D (EQ-5D) questionnaire.
Results
Peripheral nerve stimulation was successful in all but one patient. Of the 29 patients who underwent percutaneous nerve evaluation, 17 (58.62%) responded well to SNM and received permanent implants. The median follow-up period was 48 months (range, 18–153 months). The number of days per week with fecal incontinence episodes decreased from a median of 7 (range, 2–7) to 0.38 (range, 0–1). The median number of bowel movements recorded in patient diaries fell from 5 (range, 4–12) to 2 (range, 1–6). The median Wexner score decreased from 18 (range, 13–20) to 6 (range, 0–16), while the LARS score declined from 38.5 (range, 37–42) to 19 (range, 4–28). The FIQL and EQ-5D questionnaires demonstrated enhanced quality of life.
Conclusion
SNM may benefit patients diagnosed with LARS following rectal cancer surgery when conservative options have failed, and the treatment outcomes may possess long-term sustainability.

Citations

Citations to this article as recorded by

Low Anterior Resection Syndrome (LARS): A Contemporary Surgical Review of Incidence, Pathophysiology, Risk Stratification and Functional Outcomes
Supreet Kumar, Vivek Tandon, Deepak Govil
Apollo Medicine.2025;[Epub] CrossRef

Technical Note

Clinical outcomes with of the Contix Faecal Incontinence Management System: preliminary results: Moris Venturero, Reuma Yehuda-Margalit, Carla Maradey-Romero, Yael Corcos, Dan Carter, Marc Beer-Gabel; Ann Coloproctol. 2023;39(1):89-93. Published online December 6, 2022; DOI: https://doi.org/10.3393/ac.2022.00563.0080

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Abstract PDF

Fecal incontinence (FI) has a significant long-term impact on patient quality of life for which there is a range of medical and surgical management alternatives. We report the preliminary outcome using the ForConti Contix Faecal Incontinence Management System (FIMS) in FI patients who had failed conservative therapy and who were recruited at 2 tertiary institutions between September 2018 and September 2020. Comparative assessments were made before and after 2 week periods of treatment using bowel diaries and subjective Wexner and Faecal Incontinence Quality of Life scores. Of 17 patients enrolled, 11 completed an 8-week assessment with a significant fall in the average percentage of FI days reported from 84% before treatment to 16.8% at the first posttreatment assessment and down to 13.2% by the second assessment period. This finding correlated with a similar reduction in the total weekly number of episodes of frank FI, minor soiling, and fecal urgency reported by patients along with concomitant improvements in the Wexner scores. For those using the device, there was less concern about accidental bowel leakage, high rates of satisfaction, and minimal problems with the device. Initial results are encouraging warranting further study.

Citations

Citations to this article as recorded by

Novel Nonablative Radiofrequency Approach for the Treatment of Anal Incontinence: A Phase 1 Clinical Trial
Patrícia Lordêlo, Juliana Barros, Claudia Liony, Cristiane Maria Carvalho C Dias, Janine Ferreira, Priscila G Januário, Luana N Matos, Camila O Muniz, Laizza S Silva, Cristina Brasil
Cureus.2023;[Epub] CrossRef

Case Report

Benign bowel disease

A case report of a giant solitary juvenile polyp: from obstructed defecation syndrome to incontinence: Zhan Huai Teoh, Jien Yen Soh, Nasibah Mohamad, Norzaliana Zawawi, Andee Dzulkarnaen Zakaria, Zaidi Zakaria, Michael Pak-Kai Wong; Ann Coloproctol. 2024;40(Suppl 1):S27-S31. Published online November 25, 2022; DOI: https://doi.org/10.3393/ac.2022.00549.0078

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Abstract PDF: Juvenile polyps (JPs) are the most common polyps in pediatric patients. We present the case of an 18-year-old male patient with a giant solitary JP resembling solitary rectal ulcer syndrome (SRUS). The presenting history was rectal bleeding and symptoms of obstructed defecation syndrome. Colonoscopy revealed a polypoidal mass at the anorectal junction, with biopsy-confirmed SRUS. The symptoms worsened, and a protruding mass from the anus caused fecal incontinence. Pelvic magnetic resonance imaging showed a huge pedunculated mass occupying the low rectum with local compression of the urinary bladder. Transanal excision of the anal tumor was performed due to bleeding. A histopathological examination showed a JP with high-grade dysplasia. A histological examination to differentiate JPs and SRUS could be challenging based on a superficial forceps biopsy. Therefore, an excision biopsy is usually warranted with the understanding that adenomatous or malignant transformation is found in 5.6% to 12% of all JPs.

Original Article

Anorectal benign disease

Garg scoring system to predict long-term healing in cryptoglandular anal fistulas: a prospective validation study: Sushil Dawka, Vipul D. Yagnik, Baljit Kaur, Geetha R. Menon, Pankaj Garg; Ann Coloproctol. 2024;40(5):490-497. Published online October 11, 2022; DOI: https://doi.org/10.3393/ac.2022.00346.0049

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6 Citations

Abstract PDF

Purpose
Complex anal fistulas can recur after clinical healing, even after a long interval which leads to significant anxiety. Also, ascertaining the efficacy of any new treatment procedure becomes difficult and takes several years. We prospectively analyzed the validity of Garg scoring system (GSS) to predict long-term fistula healing.
Methods
In patients operated for cryptoglandular anal fistulas, magnetic resonance imaging was performed preoperatively and at 3 months postoperatively to assess fistula healing. Scores as per the GSS were calculated for each patient at 3 months postoperatively and correlated with long-term healing to check the accuracy of the scoring system.
Results
Fifty-seven patients were enrolled, but 50 were finally included (7 were excluded). These 50 patients (age, 41.2±12.4 years; 46 men) were followed up for 12 to 20 months (median, 17 months). Forty-seven patients (94.0%) had complex fistulas, 28 (56.0%) had recurrent fistulas, 48 (96.0%) had multiple tracts, 20 (40.0%) had horseshoe tracts, 15 (32.0%) had associated abscesses, 5 (10.0%) were suprasphincteric, and 8 (16.0%) were supralevator fistulas. The GSS could accurately predict long-term healing (high positive predictive value, 31 of 31 [100%]) but was not very accurate in predicting nonhealing (negative predictive value, 15 of 19 [78.9%]). The sensitivity in predicting healing was 31 of 35 (88.6%).
Conclusion
GSS accurately predicts long-term fistula with a high positive predictive value (100%) but is less accurate in predicting nonhealing. This scoring system can help allay anxiety in patients and facilitate the early validation of innovative procedures for anal fistulas.

Citations

Citations to this article as recorded by

External validation of the modified Parks classification of cryptoglandular anal fistula to predict failure of healing: the protocol for a retrospective analysis
Alireza Teymouri, Amir Keshvari, Faezeh Khorasanizadeh, Alireza Kazemeini, Behnam Behboudi, Mohammad Sadegh Fazeli, Mohammad Reza Keramati, Ali Ashjaei, Seyed Mohsen Ahmadi Tafti, Amirhosein Naseri
International Journal of Surgery Protocols.2025; 29(3): 118. CrossRef
Recent Advances in the Understanding and Management of Anal Fistula from India
Vipul D. Yagnik, Sandeep Kumar, Anshul Thakur, Kaushik Bhattacharya, Sushil Dawka, Pankaj Garg
Indian Journal of Surgery.2024; 86(6): 1105. CrossRef
Rectovaginal Fistulas Not Involving the Rectovaginal Septum Should Be Treated Like Anal Fistulas: A New Concept and Proposal for a Reclassification of Rectovaginal Fistulas
Pankaj Garg, Laxmikant Ladukar, Vipul Yagnik, Kaushik Bhattacharya, Gurleen Kaur
Clinical and Experimental Gastroenterology.2024; Volume 17: 97. CrossRef
Recent advances in the diagnosis and treatment of complex anal fistula
Pankaj Garg, Kaushik Bhattacharya, Vipul D. Yagnik, G. Mahak
Annals of Coloproctology.2024; 40(4): 321. CrossRef
Predictors of outcome in cryptoglandular anal fistula according to magnetic resonance imaging: A systematic review
Alireza Teymouri, Amir Keshvari, Ali Ashjaei, Seyed Mohsen Ahmadi Tafti, Faeze Salahshour, Faezeh Khorasanizadeh, Amirhosein Naseri
Health Science Reports.2023;[Epub] CrossRef
Pankaj Garg: A Community Doctor to a Master Innovator to a Global Icon
David N. Armstrong, Iwona Sudoł-Szopińska, Vincent de Parades, Francesco Litta, Manuel Limbert, Khaw C. W. James
Global Journal of Medical, Pharmaceutical, and Biomedical Update.2023; 18: 16. CrossRef

Review

Benign proctology

A systematic review of translation and experimental studies on internal anal sphincter for fecal incontinence: Minsung Kim, Bo-Young Oh, Ji-Seon Lee, Dogeon Yoon, Wook Chun, Il Tae Son; Ann Coloproctol. 2022;38(3):183-196. Published online June 9, 2022; DOI: https://doi.org/10.3393/ac.2022.00276.0039

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Abstract PDF

The complexity in the molecular mechanism of the internal anal sphincter (IAS) limits preclinical or clinical outcomes of fecal incontinence (FI) treatment. So far, there are no systematic reviews of IAS translation and experimental studies that have been reported. This systematic review aims to provide a comprehensive understanding of IAS critical role in FI. Previous studies revealed the key pathway for basal tone and relaxation of IAS in different properties as follows; calcium, Rho-associated, coiled-coil containing serine/threonine kinase, aging-associated IAS dysfunction, oxidative stress, renin-angiotensin-aldosterone, cyclooxygenase, and inhibitory neurotransmitters. Previous studies have reported improved functional outcomes of cellular treatment for regeneration of dysfunctional IAS, using various stem cells, but did not demonstrate the interrelationship between those results and basal tone or relaxation-related molecular pathway of IAS. Furthermore, these results have lower specificity for IAS-incontinence due to the included external anal sphincter or nerve injury regardless of the cell type. An acellular approach using bioengineered IAS showed a physiologic response of basal tone and relaxation response similar to human IAS. However, in both cellular and acellular approaches, the lack of human IAS data still hampers clinical application. Therefore, the IAS regeneration presents more challenges and warrants more advances.

Citations

Citations to this article as recorded by

A single-center retrospective analysis of endorectal advancement flaps used for the treatment of simple rectovaginal fistulas
Xuexiao Li, Wanjin Shao, Guidong Sun
Scandinavian Journal of Gastroenterology.2025; 60(4): 307. CrossRef
Anal sphincter reconstruction for fecal incontinence: Techniques, outcomes, and future directions
Hai-Liang Li, Hao-Ran Zhang, Yuan Wu, Kai-Qiang He, Tian-Jie Chen, Jing Wang
World Journal of Gastrointestinal Surgery.2025;[Epub] CrossRef
Tissue engineering and regenerative medicine approaches in colorectal surgery
Bigyan B. Mainali, James J. Yoo, Mitchell R. Ladd
Annals of Coloproctology.2024; 40(4): 336. CrossRef
3D spheroids versus 2D-cultured human adipose stem cells to generate smooth muscle cells in an internal anal sphincter-targeting cryoinjured mouse model
Iltae Son, Minsung Kim, Ji-Seon Lee, Dogeon Yoon, You-Rin Kim, Ji Hye Park, Bo-Young Oh, Wook Chun, Sung-Bum Kang
Stem Cell Research & Therapy.2024;[Epub] CrossRef
Differentiation of Adipose-Derived Stem Cells into Smooth Muscle Cells in an Internal Anal Sphincter-Targeting Anal Incontinence Rat Model
Minsung Kim, Bo-Young Oh, Ji-Seon Lee, Dogeon Yoon, You-Rin Kim, Wook Chun, Jong Wan Kim, Il Tae Son
Journal of Clinical Medicine.2023; 12(4): 1632. CrossRef
Improving Efficiency and Accuracy in English Translation Learning: Investigating a Semantic Analysis Correction Algorithm
Lingmei Cao, Junru Fu
Applied Artificial Intelligence.2023;[Epub] CrossRef

Original Articles

Colorectal cancer

Outcomes following anastomotic leak from rectal resections, including bowel function and quality of life: Angelina Di Re, Salam Tooza, Jason Diab, Charbel Karam, Mina Sarofim, Kevin Ooi, Catherine Turner, Daniel Kozman, David Blomberg, Matthew Morgan; Ann Coloproctol. 2023;39(5):395-401. Published online April 14, 2022; DOI: https://doi.org/10.3393/ac.2022.00073.0010

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15 Web of Science
16 Citations

Abstract PDF

Purpose
Anastomotic leak (AL) is an uncommon but potentially devastating complication after rectal resection. We aim to provide an updated assessment of bowel function and quality of life after AL, as well as associated short- and long-term outcomes.
Methods
A retrospective audit of all rectal resections performed at a colorectal unit and associated private hospitals over the past 10 years was performed. Relevant demographic, operative, and histopathological data were collected. A prospective survey was performed regarding patients’ quality of life and fecal continence. These patients were matched with nonAL patients who completed the same survey.
Results
One hundred patients (out of 1,394 resections) were included. AL was contained in 66.0%, not contained in 10.0%, and only anastomotic stricture in 24.0%. Management was antibiotics only in 39.0%, percutaneous drainage in 9.0%, operative abdominal drainage in 19.0%, transrectal drainage in 6.0%, combination of percutaneous drainage and transrectal drainage in 2.0%, and combination abdominal/transrectal drainage in 1.0%. The 1-year stoma rate was 15.0%. Overall, mean Fecal Incontinence Severity Instrument scores were higher for AL patients than their matched counterparts (8.06±10.5 vs. 2.92±4.92, P=0.002). Patients with an AL had a mean EuroQol visual analogue scale (EQ-VAS) of 76.23±19.85; this was lower than the matched mean EQ-VAS for non-AL patients of 81.64±18.07, although not statistically significant (P=0.180).
Conclusion
The majority of AL patients in this study were managed with antibiotics only. AL was associated with higher fecal incontinence scores in the long-term; however, this did not equate to lower quality of life scores.

Citations

Citations to this article as recorded by

Impact of timing of ileostomy reversal and anastomotic leakage on bowel function and health-related quality of life following rectal cancer surgery: a cross-sectional study
Ditte Reitz Petersen, Pia Møller Faaborg, Issam Al-Najami, Maja Mi Thygesen, Anna Pilegaard Bjarnesen Mølstrøm, Sören Möller, Mark Bremholm Ellebæk
Surgical Endoscopy.2026;[Epub] CrossRef
Impact of Anastomotic Leakage After Colorectal Cancer Surgery on Quality of Life: A Systematic Review
Anke H.C. Gielen, Danique J.I. Heuvelings, Patricia Sylla, Yu-Ting van Loon, Jarno Melenhorst, Nicole D. Bouvy, Merel L. Kimman, Stephanie O. Breukink
Diseases of the Colon & Rectum.2025; 68(2): 154. CrossRef
Fluorescence angiography with indocyanine green for low anterior resection in patients with rectal cancer: a prospective before and after study
J. Charbonneau, É. Papillon-Dion, R. Brière, N. Singbo, A. Legault-Dupuis, S. Drolet, F. Rouleau-Fournier, P. Bouchard, A. Bouchard, C. Thibault, F. Letarte
Techniques in Coloproctology.2025;[Epub] CrossRef
Circular staplers and anastomotic leakage in colorectal surgery: meta-analysis
Claudio Fiorillo, Vincenzo Tondolo, Beatrice Biffoni, Elisabetta Gambaro, Chiara Lucinato, Davide De Sio, Sergio Alfieri, Giuseppe Quero
BJS Open.2025;[Epub] CrossRef
Intraoperative fluorescence angiography with indocyanine green to prevent anastomotic leak in rectal cancer surgery (IntAct): an unblinded randomised controlled trial
David Jayne, Julie Croft, Neil Corrigan, Philip Quirke, Ronan A Cahill, Gemma Ainsworth, David M Meads, Andrew Kirby, Damian Tolan, Katie Gordon, Roel Hompes, Antonino Spinelli, Caterina Foppa, Albert M Wolthuis, André D'Hoore, Andrea Vignali, Henry S Til
The Lancet Gastroenterology & Hepatology.2025; 10(9): 806. CrossRef
Impact of anastomotic leakage and radiotherapy on long-term quality of life after sphincter-saving rectal resections
Rasim Khalilov, Steffen Seyfried, Christoph Reissfelder, Julia Hardt, Florian Herrle, Vugar Yagublu
Langenbeck's Archives of Surgery.2025;[Epub] CrossRef
Risk factors and risk prediction modelling for pelvic sepsis and anastomotic leak following robotic total mesorectal excision with primary anastomosis for rectal cancer
C. A. Fleming, R. T. J. Geitenbeek, R. Duhoky, A. Moussion, N. Bouazza, J. Khan, E. Cotte, A. Dubois, E. Rullier, R. Hompes, P. Rouanet, E. C. J. Consten, Q. Denost
Colorectal Disease.2025;[Epub] CrossRef
Association between anastomotic leak after rectal resection and bowel dysfunction, a systematic review, meta‐analysis and meta‐regression
Sameh Hany Emile, Roberta Lynn Oslin, Anjelli Wignakumar, Nir Horesh, Zoe Garoufalia, Steven D. Wexner, Marylise Boutros
Colorectal Disease.2025;[Epub] CrossRef
Does robotic circumferential oversewing reduce anastomotic leakage in stapled anastomosis for rectal cancer surgery?
J.-M. Jung, S. Yang, Y. S. Yoon, Y. I. Kim, M. H. Kim, J. L. Lee, C. W. Kim, I. J. Park, S.-B. Lim, C. S. Yu
Techniques in Coloproctology.2025;[Epub] CrossRef
Neoadjuvant Chemotherapy Without Radiation for Locally Advanced Rectal Cancer: A Meta-analysis of Surgical Outcomes After Total Mesorectal Excision
Richard Garfinkle, Saba Balvardi, Marylise Boutros, Dean A. Fergusson
Diseases of the Colon & Rectum.2025; 68(12): 1383. CrossRef
Management of anastomotic leak after elective anterior resection for rectal cancer: A systematic review and pooled analysis
Ruth Walsh, Edward Murphy, Éanna J. Ryan, Ronan A. Cahill
Colorectal Disease.2025;[Epub] CrossRef
The Effect of Post‐Treatment Combined Lifestyle Interventions on Quality of Life in Colorectal Cancer Patients – A Systematic Review
Anke H. C. Gielen, Britt J. M. Thomassen, Tim J. Bult, Jarno Melenhorst, Merel L. Kimman, Stephanie O. Breukink
Lifestyle Medicine.2024;[Epub] CrossRef
Serum nutritional predictive biomarkers and risk assessment for anastomotic leakage after laparoscopic surgery in rectal cancer patients
Paerhati Shayimu, Maitisaidi Awula, Chang-Yong Wang, Rexida Jiapaer, Yi-Peng Pan, Zhi-Min Wu, Yi Chen, Ze-Liang Zhao
World Journal of Gastrointestinal Surgery.2024; 16(10): 3142. CrossRef
Early detection of anastomotic leakage in colon cancer surgery: the role of early warning score and C-reactive protein
Gyung Mo Son
Annals of Coloproctology.2024; 40(5): 415. CrossRef
Optimal Indocyanine Green Dosage for Repetitive Angiography for Laparoscopic Colorectal Surgery
Gyung Mo Son, Sang-Ho Park, Nam Su Kim, Mi Sook Yun, In Young Lee, Myeong-Sook Kwon, Tae Kyun Kim, Eun Hwa Lee, Eun Jung Hwang, Kwang-Ryul Baek
Medicina.2024; 60(12): 1966. CrossRef
Beyond survival: a comprehensive review of quality of life in rectal cancer patients
Won Beom Jung
Annals of Coloproctology.2024; 40(6): 527. CrossRef

The pattern of bowel dysfunction in patients with rectal cancer following the multimodal treatment: anorectal manometric measurements at before and after chemoradiation therapy, and postoperative 1 year: Ri Na Yoo, Bong-Hyeon Kye, HyungJin Kim, Gun Kim, Hyeon-Min Cho; Ann Coloproctol. 2023;39(1):32-40. Published online March 11, 2022; DOI: https://doi.org/10.3393/ac.2021.00696.0099

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Graphical Abstract Abstract PDF

Purpose
Bowel dysfunction commonly occurs in patients with locally advanced rectal cancer treated with a multimodal approach of chemoradiation therapy (CRT) combined with sphincter-preserving rectal resection. This study investigated the decline in anorectal function using sequential anorectal manometric measurements obtained before and after the multimodal treatment as well as at a 1-year follow-up.
Methods
This was a retrospective cohort study conducted in a single center. The study population consisted of patients with locally advanced mid- to low rectal cancer who received the preoperative CRT followed by sphincter-preserving surgery from 2012 to 2016. The anorectal manometric value measured after each treatment modality was compared to demonstrate the degree of decline in anorectal function. A generalized linear model of repeated measures was performed using the manometric values measured pre- and post-CRT, and at 12 months postoperatively.
Results
Overall, 100 patients with 3 consecutive manometric data were included in the final analysis. In the overall cohort study, the mean resting and maximal squeezing pressures showed insignificant decrement post-neoadjuvant CRT. At a 1-year postoperative follow-up, the maximal squeezing pressure significantly decreased. The maximal rectal sensory threshold demonstrated significant reduction consecutively after each following treatment (P<0.001).
Conclusion
The short-term effect of neoadjuvant CRT on the anal sphincters was relatively trivial. The following sphincter-saving surgery resulted in a profound disruption of the anorectal function. Patients with rectal cancer should be consulted on the consequence of multimodal treatment.

Citations

Citations to this article as recorded by

Beyond survival: a comprehensive review of quality of life in rectal cancer patients
Won Beom Jung
Annals of Coloproctology.2024; 40(6): 527. CrossRef
Unveiling the profound advantages of total neoadjuvant therapy in rectal cancer: a trailblazing exploration
Kyung Uk Jung, Hyung Ook Kim, Hungdai Kim, Donghyoun Lee, Chinock Cheong
Annals of Surgical Treatment and Research.2023; 105(6): 341. CrossRef

Benign proctology,Surgical technique

Injection of aluminum potassium sulfate and tannic acid in the treatment of fecal incontinence: a single-center observational study: Tatsuya Abe, Masao Kunimoto, Yoshikazu Hachiro, Kei Ohara, Mitsuhiro Inagaki; Ann Coloproctol. 2022;38(6):403-408. Published online July 21, 2021; DOI: https://doi.org/10.3393/ac.2021.00248.0035

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4 Citations

Graphical Abstract Abstract PDF

Purpose
Perianal injection of bulking agents is an attractive treatment option for patients with mild to moderate fecal incontinence (FI). Various bulking agents have been used for injection therapy, but the optimal injection materials and methods are yet to be standardized. This study aimed to evaluate the effects of injection therapy using aluminum potassium sulfate and tannic acid (ALTA) in the management of FI.
Methods
This study included consecutive patients who underwent ALTA injection therapy for FI at our institution. The procedure was performed with the patient in the jackknife position, under caudal epidural anesthesia. The procedure consisted of a 4-step injection to the 3 main cushions and a multipoint injection to the remaining submucosa of the anal canal.
Results
Seventy-seven patients (mean age, 76 years) were enrolled in the study. The mean Cleveland Clinic incontinence score of 11.9 ± 4.1 at baseline significantly improved to 7.3 ± 5.2 at 3 months following treatment. The mean maximal resting pressure also increased significantly 3 months after the intervention. Postoperative complications were observed in 3 patients (3.9%), and all events were mild. The mean duration of postoperative follow-up was 17.5 months. The cumulative recurrence-free rate at 3 years was 72.4%.
Conclusion
ALTA injection for FI is safe, easy to perform, and provides reasonable mid-term outcomes. Moreover, concomitant anorectal diseases that may be contraindicated by other injectable bulking agents could be treated simultaneously. Therefore, ALTA injection is a promising alternative in the absence of other injectable agents.

Citations

Citations to this article as recorded by

Effective non-surgical treatment of hemorrhoids with sclerosing foam and novel injection device
Juan Cabrera Garrido, Gonzalo López González
Gastroenterology & Endoscopy.2024; 2(4): 176. CrossRef
Tissue engineering and regenerative medicine approaches in colorectal surgery
Bigyan B. Mainali, James J. Yoo, Mitchell R. Ladd
Annals of Coloproctology.2024; 40(4): 336. CrossRef
Efficacy and Safety of a New Technique Combining Injection Sclerotherapy and External Hemorrhoidectomy for Prolapsed Hemorrhoids: A Single-center Observational Study
Tatsuya Abe, Masao Kunimoto, Yoshikazu Hachiro, Akane Ito, Kenji Watanabe, Shigenori Ota, Kei Ohara, Mitsuhiro Inagaki, Yusuke Saitoh, Masanori Murakami
Journal of the Anus, Rectum and Colon.2024; 8(4): 331. CrossRef
Simple Anal Reinforcement with Anal Encirclement Using an Artificial Ligament in Patients with fecal Incontinence: A Single-center Observational Study
Tatsuya Abe, Masao Kunimoto, Yoshikazu Hachiro, Shigenori Ota, Kei Ohara, Mitsuhiro Inagaki
Journal of the Anus, Rectum and Colon.2022; 6(3): 174. CrossRef

Benign proctology,Surgical technique

Minimal Lateral Internal Sphincterotomy (LIS): Is It Enough to Cut Less Than the Conventional Tailored LIS?: Keun-Hee Lee, Keehoon Hyun, Seo-Gue Yoon, Jong-Kyun Lee; Ann Coloproctol. 2021;37(5):275-280. Published online July 9, 2021; DOI: https://doi.org/10.3393/ac.2020.00976.0139

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11 Citations

Abstract PDF

Purpose
Anal fissure is a common anorectal condition, yet its pathogenesis remains unclear. Lateral internal sphincterotomy (LIS) is the gold standard treatment for chronic anal fissures that do not respond to conservative treatment; however, it has a risk of anal incontinence. We believe that fibrosis of the internal anal sphincter is an important factor in the pathogenesis of chronic anal fissure. In this study, we describe the minimal LIS method, a minimally invasive method where only the fibrotic portion of the internal anal sphincter is cut. We also describe the outcomes of this method.
Methods
We performed a retrospective review of 468 patients (270 male and 198 female) who underwent minimal LIS for chronic anal fissure in 2017 at Seoul Song Do Hospital. We analyzed the patients’ clinical characteristics, manometry data, complications, and outcomes of minimal LIS. The outcomes of the surgery were assessed via questionnaires during the postoperative outpatient visits, beginning 2 weeks postoperatively.
Results
The overall complication rate was 4.0% (19 patients). Delayed healing occurred in 14 patients (3.0%), perianal abscess was present in 3 patients (0.6%), and gas incontinence occurred in 2 patients (0.4%). All complications were improved with conservative treatment. Recurrence, defined as the recurrence of anal fissure more than 4 weeks after healing, was present in 6 patients (1.3%).
Conclusion
Minimal LIS is a safe and effective treatment option for patients with chronic anal fissure. Postoperative complications, especially incontinence and recurrence, are rare.

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Operative Therapie der Analfissur
Ricarda Diller
coloproctology.2025; 47(4): 254. CrossRef
Current evidence and new trends in anal fissure treatment
Marta DOMÍNGUEZ-MUÑOZ, Andrea BALLA, Juan Carlos GÓMEZ-ROSADO, Salvador MORALES-CONDE
Minerva Surgery.2025;[Epub] CrossRef
The Practices and Preferences of Turkish Surgeons in the Treatment of Anal Fissure
Ümit Özdemir, Necip Tolga Baran, Ahmet Seki
Journal of Coloproctology.2025; 45(03): 001. CrossRef
Management of Hemorrhoids and Anal Fissures
Oladapo Akinmoladun, William Oh
Surgical Clinics of North America.2024; 104(3): 473. CrossRef
Anal Fissure and Its Treatments: A Historical Review
Cristiana Riboni, Lucio Selvaggi, Francesco Cantarella, Mauro Podda, Salvatore Bracchitta, Vinicio Mosca, Angelo Cosenza, Vincenzo Cosenza, Francesco Selvaggi, Bruno Nardo, Francesco Pata
Journal of Clinical Medicine.2024; 13(13): 3930. CrossRef
Botulinum toxin injection versus lateral internal sphincterotomy for chronic anal fissure: a meta-analysis of randomized control trials
Ali Bonyad, Reza Hossein Zadeh, Setareh Asgari, Fatemeh Eghbal, Pardis Hajhosseini, Hani Ghadri, Niloofar Deravi, Reza Shah Hosseini, Mahdyieh Naziri, Rasoul Hossein Zadeh, Yaser khakpour, Sina Seyedipour
Langenbeck's Archives of Surgery.2024;[Epub] CrossRef
Modern trends and priority in treatment of chronic anal fissure
S. A. Aliev, E. S. Aliev
Grekov's Bulletin of Surgery.2024; 183(4): 77. CrossRef
New Findings at the Internal Anal Sphincter on Cadaveric Dissection and Review of Sphincter-Related Surgery in a Newer Prospective
Aswini Kumar Pujahari
Indian Journal of Surgery.2023; 85(3): 585. CrossRef
Long-term Efficacy and Safety of Controlled Manual Anal Dilatation in the Treatment of Chronic Anal Fissures: A Single-center Observational Study
Tatsuya Abe, Masao Kunimoto, Yoshikazu Hachiro, Shigenori Ota, Kei Ohara, Mitsuhiro Inagaki, Yusuke Saitoh, Masanori Murakami
Journal of the Anus, Rectum and Colon.2023; 7(4): 250. CrossRef
The Association of Coloproctology of Great Britain and Ireland guideline on the management of anal fissure
Katie L. R. Cross, Steven R. Brown, Jos Kleijnen, James Bunce, Melanie Paul, Sophie Pilkington, Oliver Warren, Oliver Jones, Jon Lund, Henry J. Goss, Michael Stanton, Tatenda Marunda, Artaza Gilani, L. Wee Sing Ngu, Philip Tozer
Colorectal Disease.2023; 25(12): 2423. CrossRef
Is It a Refractory Disease?- Fecal Incontinence; beyond Medication
Chungyeop Lee, Jong Lyul Lee
The Ewha Medical Journal.2022;[Epub] CrossRef

Benign GI diease,Benign diesease & IBD

Long-term evolution of continence and quality of life after sphincteroplasty for obstetric fecal incontinence: Vicente Pla-Martí, Jose Martín-Arévalo, Rosa Martí-Fernández, David Moro-Valdezate, Stephanie García-Botello, Alejandro Espí-Macías, Miguel Mínguez-Pérez, Maria Dolores Ruiz-Carmona, Jose Vicente Roig-Vila; Ann Coloproctol. 2022;38(1):13-19. Published online September 18, 2020; DOI: https://doi.org/10.3393/ac.2020.09.16

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Abstract PDF

Purpose
This study was performed to evaluate the long-term evolution of continence and patient’s quality of life after surgical treatment for obstetric fecal incontinence.
Methods
A prospective longitudinal study was conducted including consecutive patients who underwent sphincteroplasty for severe obstetric fecal incontinence. The first phase analyzed changes in continence and impact on quality of life. The second phase studied the long-term evolution reevaluating the same group of patients 6 years later. Degree of fecal incontinence was calculated using the Cleveland Clinic Score (CCS). Quality of life assessment was carried out with the Fecal Incontinence Quality of Life scale.
Results
Thirty-five patients with median age of 55 years (range, 28 to 73 years) completed the study. Phase 1 results: after a postoperative follow-up of 30 months (4 to 132 months), CCS had improved significantly from a preoperative of 15.7 ± 3.1 to 6.1 ± 5.0 (P < 0.001). Phase 2 results: median follow-up in phase 2 was 110 months (76 to 204 months). The CCS lowered to 8.4 ± 4.9 (P = 0.04). There were no significant differences between phases 1 and 2 in terms of quality of life; lifestyle (3.47 ± 0.75 vs. 3.16 ±1.04), coping/behavior (3.13 ±0.83 vs. 2.80 ±1.09), depression/self-perception (3.65 ±0.80 vs. 3.32 ± 0.98), and embarrassment (3.32 ± 0.90 vs. 3.12 ± 1.00).
Conclusion
Sphincteroplasty offers good short-medium term outcomes in continence and quality of life for obstetric fecal incontinence treatment. Functional clinical results deteriorate over time but did not impact on patients’ quality of life.

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Obstetric anal sphincter injuries (OASIS) and secondary overlapping sphincteroplasty from a colorectal perspective: A Systematic Review
Abdel Latif Khalifa Elnaim, Michael P.K. Wong, Ismail Sagap
Academic Medicine & Surgery.2025;[Epub] CrossRef
Comparative outcomes of sphincteroplasty and sacral neuromodulation in postmenopausal women with late-onset fecal incontinence following obstetric trauma: a retrospective study
Alessandro Bergna, Andrea Rusconi, Jacques Megevand, Ettore Lillo, Massimo Amboldi, Alessio Lanzaro, Leonardo Lenisa, Ezio Ganio
Updates in Surgery.2025;[Epub] CrossRef
Obstetric Anal Sphincter Injuries: A Urogynecologic Perspective on Detection and Diagnosis
Katarzyna Borycka, Diaa E. E. Rizk
International Urogynecology Journal.2025; 36(11): 2187. CrossRef
Anal sphincter reconstruction for fecal incontinence: Techniques, outcomes, and future directions
Hai-Liang Li, Hao-Ran Zhang, Yuan Wu, Kai-Qiang He, Tian-Jie Chen, Jing Wang
World Journal of Gastrointestinal Surgery.2025;[Epub] CrossRef
Laser Hemorrhoidoplasty: Postoperative Outcomes and Predictive Factors for Pain, Bleeding, and Recovery
Laurențiu Augustus Barbu, Nicolae-Dragoș Mărgăritescu, Liliana Cercelaru, Tiberiu Stefăniță Țenea Cojan, Mădălina Costinela Stănică, Irina Enăchescu, Ana-Maria Țenea Cojan, Valentina Căluianu, Gabriel Florin Răzvan Mogoș, Liviu Vasile
Life.2025; 15(11): 1777. CrossRef
Efficacy of Sacral Neuromodulation in Treatment of Fecal Incontinence Associated With Anal Sphincter Defects: A Systematic Review and Meta‐Analysis
Sameh Hany Emile, Anjelli Wignakumar, Nir Horesh, Zoe Garoufalia, Marcus Oosenbrug, Victor Strassmann, Steven D. Wexner
World Journal of Surgery.2025;[Epub] CrossRef
Baiona’s Consensus Statement for Fecal Incontinence. Spanish Association of Coloproctology
Javier Cerdán Miguel, Antonio Arroyo Sebastián, Antonio Codina Cazador, Fernando de la Portilla de Juan, Mario de Miguel Velasco, Alberto de San Ildefonso Pereira, Fernando Jiménez Escovar, Franco Marinello, Mónica Millán Scheiding, Arantxa Muñoz Duyos, M
Cirugía Española (English Edition).2024; 102(3): 158. CrossRef
Diagnostic tools for fecal incontinence: Scoring systems are the crucial first step
Peter Liptak, Martin Duricek, Peter Banovcin
World Journal of Gastroenterology.2024; 30(6): 516. CrossRef
Consenso Baiona sobre Incontinencia Fecal: Asociación Española de Coloproctología
Javier Cerdán Miguel, Antonio Arroyo Sebastián, Antonio Codina Cazador, Fernando de la Portilla de Juan, Mario de Miguel Velasco, Alberto de San Ildefonso Pereira, Fernando Jiménez Escovar, Franco Marinello, Mónica Millán Scheiding, Arantxa Muñoz Duyos, M
Cirugía Española.2024; 102(3): 158. CrossRef
How to Avoid Becoming a Risk Factor of Fecal Incontinence Due to OASIS—A Narrative Review
Nikodem Horst
Journal of Clinical Medicine.2024; 13(17): 5071. CrossRef
The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Management of Fecal Incontinence
Liliana G. Bordeianou, Amy J. Thorsen, Deborah S. Keller, Alexander T. Hawkins, Craig Messick, Lucia Oliveira, Daniel L. Feingold, Amy L. Lightner, Ian M. Paquette
Diseases of the Colon & Rectum.2023; 66(5): 647. CrossRef
Validation of the Turkish version of the Quality of Life in Patients with Anal Fistula Questionnaire
Mehmet Ali Koç, Kerem Özgü, Derya Gökmen, Mehmet Süha Sevinç, Şiyar Ersöz, Cihangir Akyol
Turkish Journal of Colorectal Disease.2023; 33(4): 124. CrossRef
A systematic review of translation and experimental studies on internal anal sphincter for fecal incontinence
Minsung Kim, Bo-Young Oh, Ji-Seon Lee, Dogeon Yoon, Wook Chun, Il Tae Son
Annals of Coloproctology.2022; 38(3): 183. CrossRef
Is It a Refractory Disease?- Fecal Incontinence; beyond Medication
Chungyeop Lee, Jong Lyul Lee
The Ewha Medical Journal.2022;[Epub] CrossRef

Benign proctology

Propiverine Hydrochloride as a Treatment for Fecal Incontinence: Yasue Irei, Shota Takano, Kazutaka Yamada; Ann Coloproctol. 2020;36(2):88-93. Published online March 16, 2020; DOI: https://doi.org/10.3393/ac.2019.09.30.2

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Abstract PDF

Purpose
Propiverine hydrochloride (PH) is widely used for the treatment of urinary incontinence (UI) due to bladder overactivity. Moreover, the comorbidity of UI with fecal incontinence (FI) is known to be due to the relationship of both to nervous system disorders and dysfunction or weakening of the pelvic floor muscles. The aim of this single-arm prospective study was to evaluate the therapeutic value of PH for FI.Methods: Patients (n = 24) who were diagnosed as having both FI and UI from April 2015 to November 2016 were included in the study and administered a dosage of 10–20 mg PH every day for 1 month. The primary endpoint was to create a reduction in the frequency of FI per week. An evaluation criterion of ≥50% reduction in frequency was determined as effective. The percentage of the patients who achieved the ≥50% endpoint (responders) was also calculated.Results: The frequency of FI per week was 6.0 ± 8.2 (0.25–30) at baseline and reduced to 1.6 ± 2.1 (0–7) at the posttherapeutic state (P = 0.005). A reduction of ≥50% was seen in 14 of the patients (58.3%).Conclusion: PH reduced the frequency of FI in patients with both FI and UI. This study introduces a possible therapeutic option for the pharmacological treatment of FI.

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The Japan Society of Coloproctology Practice Guidelines for Fecal Incontinence 2024 (Revised Second Edition)
Keiji Koda, Toshiki Mimura, Tetsuo Yamana, Mitsuru Ishizuka, Tomoko Takahashi, Shota Takano, Tatsuya Abe, Yuji Nishizawa, Hidetoshi Katsuno, Masami Sato, Kaoru Nishimura, Masahiro Yoshida, Kotaro Maeda
Journal of the Anus, Rectum and Colon.2026; 10(1): 64. CrossRef
A systematic review of translation and experimental studies on internal anal sphincter for fecal incontinence
Minsung Kim, Bo-Young Oh, Ji-Seon Lee, Dogeon Yoon, Wook Chun, Il Tae Son
Annals of Coloproctology.2022; 38(3): 183. CrossRef
Is It a Refractory Disease?- Fecal Incontinence; beyond Medication
Chungyeop Lee, Jong Lyul Lee
The Ewha Medical Journal.2022;[Epub] CrossRef

Case Report

Benign proctology

Complex Obstetric Perineal Injury Reconstruction Using Antropyloric Valve Transposition: Saket Kumar, Noushif Medappil, Sunil Kumar Singh, Abhijit Chandra; Ann Coloproctol. 2020;36(1):58-61. Published online February 29, 2020; DOI: https://doi.org/10.3393/ac.2018.08.21

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Despite significant advancements in the field of medicine, management of complex obstetric perineal injuries remains a challenge. Although several surgical techniques have been described, no techniques have provided satisfactory long-term results. Recently, a perineal transposed antropyloric valve has been used for anorectal reconstruction in patients with damaged or excised anal sphincters. We describe this technique in the case of complex obstetric perineal trauma with extensive tissue loss, presenting with end stage fecal incontinence. The functional outcome after this procedure was evaluated. The patient tolerated the surgery well, and there were no procedure-related upper gastrointestinal disturbances. Short-term functional outcomes were encouraging. At the 36-month follow-up, the patient’s neoanal resting and squeeze pressures were 50 and 70 mmHg, respectively. The postoperative St. Mark’s incontinence score was 7. Perineal antropyloric valve transposition is feasible and can be successfully applied in the management of end-stage fecal incontinence associated with complex obstetric perineal injury.

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Is It a Refractory Disease?- Fecal Incontinence; beyond Medication
Chungyeop Lee, Jong Lyul Lee
The Ewha Medical Journal.2022;[Epub] CrossRef

Original Articles

Anorectal Manometry Versus Patient-Reported Outcome Measures as a Predictor of Maximal Treatment for Fecal Incontinence: Lisa Ramage, Shengyang Qiu, Zhu Yeap, Constantinos Simillis, Christos Kontovounisios, Paris Tekkis, Emile Tan; Ann Coloproctol. 2019;35(6):319-326. Published online December 31, 2019; DOI: https://doi.org/10.3393/ac.2018.10.16

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Abstract PDF

Purpose
This study aims to establish the ability of patient-reported outcome measures (PROMs) and anorectal manometry (ARM) in predicting the need for surgery in patients with fecal incontinence (FI).
Methods
Between 2008 and 2015, PROMs data, including the Birmingham Bowel and Urinary Symptoms Questionnaire (BBUSQ), Short Form 36 (SF-36), Wexner Incontinence Score and ARM results, were prospectively collected from 276 patients presenting with FI. Spearman rank was used to assess correlations between specific PROMs questions and ARM assessments of sphincter motor function. Binomial regression analyses were performed to identify factors predictive of the need for surgery. Finally, receiver operating characteristic (ROC) curve analyses were performed to establish the utility of individual ARM and PROMs variables in predicting the need for surgical intervention in patients with FI.
Results
Two hundred twenty-eight patients (82.60%) were treated conservatively while 48 (17.39%) underwent surgery. On univariate analyses, all 4 domains of the BBUSQ, all 8 domains of the SF-36, and the Wexner Incontinence Score were significant predictors of surgery. Additionally, maximum resting pressure, 5-second squeeze endurance, threshold volume, and urge volume were significant. On ROC curve analyses, the only significant ARM measurement was the 5-second squeeze endurance. PROMs, such as the incontinence domain of the BBUSQ and five of the SF-36 domains, were identified as fair discriminators of the need for surgery.
Conclusion
PROMs are reliable predictors of maximal treatment in patients with FI and can be readily used in primary care to aid surgical referrals and can be applied in hospital settings as an aid to guide surgical treatment decisions.

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Capturing Patient Reported Outcomes Following Treatment of Benign Anorectal Disease Requires Significant Surgeon Commitment: Do Surgeons Really Want to Know?
Thomas Peponis, Marc S. Rubin, Ronald Bleday, Harrison T. Hubbell, Robert N. Goldstone, Joel E. Goldberg, Khawaja F. Ahmed, Liliana G. Bordeianou
World Journal of Colorectal Surgery.2025; 14(1): 1. CrossRef
Clinical Grade of Obstetric Anal Sphincter Injuries and Prediction of Mode of Birth Recommendations: A 20‐Year Retrospective Analysis
Nicola Adanna Okeahialam, Ranee Thakar, Abdul H. Sultan
BJOG: An International Journal of Obstetrics & Gynaecology.2025; 132(12): 1802. CrossRef
Correlation of Digital Rectal Examination and Anorectal Manometry with Patient-Reported Outcomes Among Women with Fecal Incontinence
Alayne Markland, Mary Ackenbom, Uduak Andy, Ben Carper, Eric Jelovsek, Douglas Luchristt, Shawn Menefee, Rebecca Rogers, Vivian Sung, Donna Mazloomdoost, Maria Gantz
International Urogynecology Journal.2024; 35(12): 2367. CrossRef
Pelvic floor investigations for anal incontinence: Are they useful to predict outcomes from conservative treatment?
Karina Cuinas, Linda Ferrari, Carlene Igbedioh, Deepa Solanki, Andrew Williams, Alexis Schizas, Alison Hainsworth
Neurourology and Urodynamics.2023; 42(5): 1122. CrossRef
Anorectal dysfunction in multiple sclerosis patients: A pilot study on the effect of an individualized rehabilitation approach
Martina Kovari, Jan Stovicek, Jakub Novak, Michaela Havlickova, Sarka Mala, Andrew Busch, Pavel Kolar, Alena Kobesova
NeuroRehabilitation.2022; 50(1): 89. CrossRef
Postpartum fecal incontinence. State of the problem
D.R. Markaryan, A.M. Lukyanov, T.N. Garmanova, M.A. Agapov, V.A. Kubyshkin
Khirurgiya. Zhurnal im. N.I. Pirogova.2022; (6): 127. CrossRef
Functional outcomes after sphincter-preserving surgeries for low-lying rectal cancer: A review
Eun Jung Park, Seung Hyuk Baik
Precision and Future Medicine.2021; 5(4): 164. CrossRef
Usefulness of Patient-Reported Outcome Measures and Anorectal Physiologic Tests in Predicting Clinical Outcome for Fecal Incontinence
Chang-Nam Kim
Annals of Coloproctology.2019; 35(6): 289. CrossRef

Effectiveness of Autologous Fat Graft in Treating Fecal Incontinence: Hyeonseok Jeong, Sung Hwan Hwang, Hyoung Rae Kim, Kil O Ryu, Jiyong Lim, Hye Mi Yu, Jihoon Yoon, Chee Young Kim, Kwang-Yong Jeong, Young Jae Jung, In Seob Jeong, Young Gil Choi; Ann Coloproctol. 2019;35(3):144-151. Published online June 30, 2019; DOI: https://doi.org/10.3393/ac.2018.09.15

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Abstract PDF

Purpose
The most common risk factor for fecal incontinence (FI) is obstetric injury. FI affects 1.4%–18% of adults. Most patients are unaware when they are young, when symptoms appear suddenly and worsen with aging. Autologous fat graft is widely used in cosmetic surgical field and may substitute for injectable bulky agents in treating FI. Authors have done fat graft for past several years. This article reports the effectiveness of the fat graft in treating FI and discusses satisfaction with the procedure.
Methods
Fat was harvested from both lateral thighs using 10-mL Luer-loc syringe. Pure fat was extracted from harvests and mixed with fat, oil, and tumescent through refinement. Fats were injected into upper border of posterior ano-rectal ring, submucosa of anal canal and intersphincteric space. Thirty-five patients with FI were treated with this method from July 2016 to February 2017 in Busan Hangun Hospital. They were 13 male (mean age, 60.8 years) and 22 female patients (mean age, 63.3 years). The Wexner score was checked before procedure. We evaluated outcome in outpatients by asking the patients. For 19 patients we checked the Wexner score after procedure.
Results
Symptom improved in 29 (82.9%), and not improved in 6 (17.1%). In 2 of 6 patients, they felt better than before procedure, although not satisfied. No improvement in 4. Mean Wexner score was 9.7 before procedure. There were no serious complications such as inflammation or fat embolism.
Conclusion
Autologous fat graft can be an effective alternative treatment for FI. It is safe and easy to perform, and cost effective.

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Regenerative Approach With Autologous Fat Grafting and Stem Cells for the Treatment of Post‐Traumatic Anal Incontinence: A Case Report
Alexandre da Silva Nishimura, Giuliana Donoso Andrade Silva, Vitor Holmo Figueira, Eduardo Isaac Nishimoto, Pedro Luiz Nishimura Menardi, Igor Rincon Gonçalves Passaglia, Sabrina Thalita dos Reis
Clinical Case Reports.2026;[Epub] CrossRef
Cell-assisted lipotransfer in treating uncontrollable sepsis associated perianal fistula: a pilot study
In Seob Jeong, Sung Hwan Hwang, Hye Mi Yu, Hyeonseok Jeong
Annals of Coloproctology.2024; 40(2): 169. CrossRef
Efficacy of injection of autologous adipose tissue in the treatment of patients with complex and recurrent fistula-in-ano of cryptoglandular origin
S. Guillaumes, N. J. Hidalgo, I. Bachero, R. Pena, S. T. Nogueira, J. Ardid, M. Pera
Techniques in Coloproctology.2024;[Epub] CrossRef
Role of Autologous Fat Grafting in the Conservative Treatment of Fecal Incontinence in Children
Valentina Pinto, Marco Pignatti, Giovanni Parente, Neil Di Salvo, Luca Contu, Mario Lima
Journal of Clinical Medicine.2023; 12(4): 1258. CrossRef
Clinical and physiological efficacy of the application of autologous fat with platelet rich plasma in treating faecal incontinence
Elvis Vargas Castillo, Ingrid Melo Amaral, Arisel Domínguez, Sthephfania López, Daniel Chiantera, Mariangela Pérez Paz, Jenils Daniela Coacuto, Andrés Eloy Soto
Journal of Coloproctology.2020; 40(03): 227. CrossRef
Preliminary Study on the Echo-Assisted Intersphincteric Autologous Microfragmented Adipose Tissue Injection to Control Fecal Incontinence in Children Operated for Anorectal Malformations
Giovanni Parente, Valentina Pinto, Neil Di Salvo, Simone D’Antonio, Michele Libri, Tommaso Gargano, Vincenzo Davide Catania, Giovanni Ruggeri, Mario Lima
Children.2020; 7(10): 181. CrossRef

Safety and Efficacy of Permacol Injection in the Treatment of Fecal Incontinence: Yahya A Al-Abed, Jennifer Ayers, Abraham Ayantunde, Bandipalyam V Praveen; Ann Coloproctol. 2016;32(2):73-78. Published online April 30, 2016; DOI: https://doi.org/10.3393/ac.2016.32.2.73

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Abstract PDF

Purpose

Permacol has been gaining popularity in recent times for the treatment of fecal incontinence (FI). This study aims to evaluate the safety and efficacy of anal submucosal Permacol injection in the treatment of FI.

Methods

All consecutive patients who underwent Permacol injection for FI over a 3-year period were included. Patients' data relating to obstetric history, anorectal/pelvic operations, type of FI, preoperative anorectal physiology results and follow-up details for outcome measures were collected. Preoperative and postoperative Cleveland Clinic Florida Incontinence Scores (CCFISs) were noted. Patients were surveyed by using a telephone questionnaire to assess the quality of life and other outcome measures. Data were analysed using SPSS ver.19.0.

Results

Thirty patients (28 females and 2 males) with a median age of 67 years were included in the study. Of those patients, 37%, 50%, and 13% were noted to have passive, mixed and urge FI, respectively. Six of the patients (20%) had repeat Permacol injections, 5 of whom had sustained responses to the first Permacol injection for a mean of 11 months. There was a significant improvement in the CCFIS from a baseline median of 12.5, mean 12.8 interquartile range [IQR], 6–20), to a median of 3.5, mean 4.8 (IQR, 0–20), P < 0.001. Of the patients surveyed by telephone 89% were satisfied with their overall experience and the improvement in their symptoms following Permacol injections.

Conclusion

This study has demonstrated that Permacol injection for the treatment of FI is safe and effective and has no associated major complications. However, the results are not permanent; consequently, a significant proportion of the patients with an initial response may require repeat injections.

Citations

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Effectiveness of Autologous Fat Graft in Treating Fecal Incontinence
Hyeonseok Jeong, Sung Hwan Hwang, Hyoung Rae Kim, Kil O Ryu, Jiyong Lim, Hye Mi Yu, Jihoon Yoon, Chee Young Kim, Kwang-Yong Jeong, Young Jae Jung, In Seob Jeong, Young Gil Choi
Annals of Coloproctology.2019; 35(3): 144. CrossRef
Functional Outcome of Human Adipose Stem Cell Injections in Rat Anal Sphincter Acute Injury Model
Kirsi Kuismanen, Miia Juntunen, Nathaniel Narra Girish, Heikki Tuominen, Heini Huhtala, Kari Nieminen, Jari Hyttinen, Susanna Miettinen
Stem Cells Translational Medicine.2018; 7(3): 295. CrossRef
Sacral neuromodulation compared with injection of bulking agents for faecal incontinence following obstetric anal sphincter injury – a randomized controlled trial
M. Rydningen, T. Dehli, T. Wilsgaard, A. Rydning, M. Kumle, R. O. Lindsetmo, S. Norderval
Colorectal Disease.2017;[Epub] CrossRef
Role of Permacol Injection in the Treatment of Patients With Fecal Incontinence
Doo Han Lee
Annals of Coloproctology.2016; 32(2): 49. CrossRef

Biofeedback Therapy Before Ileostomy Closure in Patients Undergoing Sphincter-Saving Surgery for Rectal Cancer: A Pilot Study: Jeong-Ki Kim, Byeong Geon Jeon, Yoon Suk Song, Mi Sun Seo, Yoon-Hye Kwon, JI Won Park, Seung-Bum Ryoo, Seung-Yong Jeong, Kyu Joo Park; Ann Coloproctol. 2015;31(4):138-143. Published online August 31, 2015; DOI: https://doi.org/10.3393/ac.2015.31.4.138

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Abstract PDF

Purpose

This study prospectively investigated the effects of biofeedback therapy on objective anorectal function and subjective bowel function in patients after sphincter-saving surgery for rectal cancer.

Methods

Sixteen patients who underwent an ileostomy were randomized into two groups, one receiving conservative management with the Kegel maneuver and the other receiving active biofeedback before ileostomy closure. Among them, 12 patients (mean age, 57.5 years; range, 38 to 69 years; 6 patients in each group) completed the study. Conservative management included lifestyle modifications, Kegel exercises, and medication. Patients were evaluated at baseline and at 1, 3, 6, and 12 months after ileostomy closure by using anal manometry, modified Wexner Incontinence Scores (WISs), and fecal incontinence quality of life (FI-QoL) scores.

Results

Before the ileostomy closure, the groups did not differ in baseline clinical characteristics or resting manometric parameters. After 12 months of follow-up, the biofeedback group demonstrated a statistically significant improvement in the mean maximum squeezing pressure (from 146.3 to 178.9, P = 0.002). However, no beneficial effect on the WIS was noted for biofeedback compared to conservative management alone. Overall, the FI-QoL scores were increased significantly in both groups after ileostomy closure (P = 0.006), but did not differ significantly between the two groups.

Conclusion

Although the biofeedback therapy group demonstrated a statistically significant improvement in the maximum squeezing pressure, significant improvements in the WISs and the FI-QoL scores over time were noted in both groups. The study was terminated early because no therapeutic benefit of biofeedback had been demonstrated.

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Min Jeong Kim, Seonmi Yeom, Young Man Kim
European Journal of Oncology Nursing.2025; 77: 102918. CrossRef
BENEFÍCIOS DA FISIOTERAPIA EM PACIENTES COLOSTOMIZADOS E ILEOSTOMIZADOS: UMA REVISÃO NARRATIVA
Ana Carolina Aboukalam da Cruz, Anderson Viana Pantoja, Leonardo Gomes de Souza, Maicon Maximiliano de Almeida, Marcus Vinicius Henriques Brito, George Alberto da Silva Dias
REVISTA FOCO.2025; 18(7): e9137. CrossRef
The effectiveness of physiotherapy interventions on fecal incontinence and quality of life following colorectal surgery: a systematic review and meta-analysis of randomized controlled trials
Ming Yan Pun, Pak Ho Leung, Tsz Ching Chan, Chunn Pang, Kin Hei Chan, Priya Kannan
Supportive Care in Cancer.2024;[Epub] CrossRef
Application of pelvic floor rehabilitation in patients with colorectal cancer: a scoping review
Lu Zhou, Changkun Zhong, Yuanyuan Su, Zhengyang Zhang, Ling Wang
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Young Man Kim, Eui Geum Oh
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N. Blanco, I. Oliva, P. Tejedor, E. Pastor, A. Alvarellos, C. Pastor, J. Baixauli, J. Arredondo
Techniques in Coloproctology.2023; 27(12): 1251. CrossRef
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Seung‐Bum Ryoo
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Predictors of Fecal Incontinence and Related Quality of Life After a Total Mesorectal Excision With Primary Anastomosis for Patients With Rectal Cancer: Marieke S. Walma, Verena N. N. Kornmann, Djamila Boerma, Marnix A. J. de Roos, Henderik L. van Westreenen; Ann Coloproctol. 2015;31(1):23-28. Published online February 28, 2015; DOI: https://doi.org/10.3393/ac.2015.31.1.23

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Abstract PDF

Purpose

After total mesorectal excision (TME) with primary anastomosis for patients with rectal cancer, the quality of life (QoL) may be decreased due to fecal incontinence. This study aimed to identify predictors of fecal incontinence and related QoL.

Methods

Patients who underwent TME with primary anastomosis for rectal cancer between December 2008 and June 2012 completed the fecal incontinence quality of life scale (FIQoL) and Wexner incontinence score. Factors associated with these scores were identified using a linear regression analysis.

Results

A total of 80 patients were included. Multivariate analysis identified a diverting ileostomy (n = 58) as an independent predictor of an unfavorable outcome on the FIQoL subscale coping/behavior (P = 0.041). Ileostomy closure within and after 3 months resulted in median Wexner scores of 5.0 (interquartile range [IQR], 2.5-8.0) and 10.5 (IQR, 6.0-13.8), respectively (P < 0.001). The median FIQoL score was 15.0 (IQR, 13.1-16.0) for stoma closure within 3 months versus 12.0 (IQR, 10.5-13.9) for closure after 3 months (P = 0.001).

Conclusion

A diverting ileostomy is a predictor for an impaired FIQoL after a TME for rectal cancer. Stoma reversal within 3 months showed better outcomes than reversal after 3 months. Patients with a diverting ileostomy should be informed about the impaired QoL, even after stoma closure.

Citations

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Review

Pelvic Floor Rehabilitation to Improve Functional Outcome After a Low Anterior Resection: A Systematic Review: Wilhelmina S Visser, Wouter W te Riele, Djamila Boerma, Bert van Ramshorst, Henderik L van Westreenen; Ann Coloproctol. 2014;30(3):109-114. Published online June 23, 2014; DOI: https://doi.org/10.3393/ac.2014.30.3.109

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105 Citations

Abstract PDF

Purpose

Impaired functional outcome is common after a low anterior resection (LAR). Pelvic floor rehabilitation (PFR) might improve functional outcome after a LAR. The aim of this systematic review is to evaluate the effectiveness of PFR in improving functional outcome.

Methods

PubMed, Embase, and the Cochrane Library were searched using the terms fecal incontinence, colorectal neoplasm/surgery, LAR, rectal cancer, anterior resection syndrome, bowel habit, pelvic floor, training, therapy, physical therapy, rehabilitation and biofeedback. Of the 125 identified records, 5 articles were included.

Results

The 5 included studies reported on 321 patients, of which 286 patients (89%) underwent pelvic floor training. Three studies included patients with anterior resection syndrome after a LAR while the remaining studies included a series of patients after a LAR. Functional outcome was mostly assessed by using the Wexner incontinence scale. Quality of life was assessed in one study, and in three studies, rectal manometry was performed. After PFR, the functional outcome was improved in four studies, as was the quality of life.

Conclusion

This systematic review demonstrated that PFR is useful for improving the functional outcome after a LAR. The data are extracted from studies of limited quality, but the available evidence points to the effectiveness of the procedure.

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Original Article

Delorme's Procedure: An Effective Treatment for a Full-Thickness Rectal Prolapse in Young Patients: Mohammad Sadegh Fazeli, Ali Reza Kazemeini, Amir Keshvari, Mohammad Reza Keramati; Ann Coloproctol. 2013;29(2):60-65. Published online April 30, 2013; DOI: https://doi.org/10.3393/ac.2013.29.2.60

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Abstract PDF

Purpose

Delorme's procedure is infrequently applied in young adults because of its assumed higher recurrence rate. The aim of this prospective study was to assess the efficacy of the Delorme's technique in younger adults.

Methods

Fifty-two consecutive patients were entered in our study. We followed patients for at least 30 months. Their complaints and clinical exam results were noted.

Results

Our study included 52 patients (mean age, 38.44 years; standard deviation, 13.7 years). Of the included patients, 41 (78.8%) were younger than 50 years of age, and 11 (21.1%) were older than 50 years of age. No postoperative mortalities or major complications were noted. Minor complications were seen in 5 patients (9.6%) after surgery. The mean hospital stay was 2.5 days. In the younger group (age ≤50 years), fecal incontinence was improved in 92.3% (12 out of 13 with previous incontinence) of the patients, and recurrence was seen in 9.75% (4 patients). In the older group (age >50 years), fecal incontinence was improved in 20% (1 out of 5 with previous incontinence) of the patients, and recurrence was seen in 18.2% (2 patients). In 50% of the patients with a previous recurrence (3 out of 6 patients) following Delorme's procedure as a secondary procedure, recurrence was observed.

Conclusion

Delorme's procedure, especially in younger patients, is a relatively safe and effective treatment and should not be restricted to older frail patients. This procedure may not be suitable for recurrent cases.

Citations

Citations to this article as recorded by

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Reviews

New Techniques for Treating an Anal Fistula: Kee Ho Song; J Korean Soc Coloproctol. 2012;28(1):7-12. Published online February 29, 2012; DOI: https://doi.org/10.3393/jksc.2012.28.1.7

18,701 View
130 Download
20 Citations

Abstract PDF

Surgery for an anal fistula may result in recurrence or impairment of continence. The ideal treatment for an anal fistula should be associated with low recurrence rates, minimal incontinence and good quality of life. Because of the risk of a change in continence with conventional techniques, sphincter-preserving techniques for the management complex anal fistulae have been evaluated. First, the anal fistula plug is made of lyophilized porcine intestinal submucosa. The anal fistula plug is expected to provide a collagen scaffold to promote tissue in growth and fistula healing. Another addition to the sphincter-preserving options is the ligation of intersphincteric fistula tract procedure. This technique is based on the concept of secure closure of the internal opening and concomitant removal of infected cryptoglandular tissue in the intersphincteric plane. Recently, cell therapy for an anal fistula has been described. Adipose-derived stem cells have two biologic properties, namely, ability to suppress inflammation and differentiation potential. These properties are useful for the regeneration or the repair of damaged tissues. This article discusses the rationales for, the estimated efficacies of, and the limitations of new sphincter-preserving techniques for the treatment of anal fistulae.

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Muscle Regeneration: Research for the Treatment of Fecal Incontinence.: Kang, Sung Bum , Lee, Taek Gu; J Korean Soc Coloproctol. 2010;26(1):1-7.; DOI: https://doi.org/10.3393/jksc.2010.26.1.1

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Abstract PDF

Fecal incontinence remains a socially isolating condition, which can have a profound impact on all aspects of quality of life. It affects 2% to 17% of people living in the community and is an iatrogenic disease that develops after a restorative proctectomy for rectal cancer. Conservative management, such as biofeedback and medication, or surgical therapy may be ineffective, the symptomatic benefit being disappointing. In a few recent reports, autologous myoblasts injected into the urinary or anal sphincter were used successfully for the treatment of incontinence, and these cells improved the muscle function. These autologous cell therapies can avoid adverse events, such as tumor formation, compared to the use of embryonic stem cells. However, the limited regenerative capacity of cell therapy has prompted the development of replacing dysfunctional muscle tissue. Regenerative medicine for functioning muscles may be a therapeutic tool for fecal incontinence in the future. Now, many challenges remain to be overcome prior to reaching the ultimate goal of a fully functional 3-D vascularized engineered muscle: These include development of highly organized 3-D scaffolds, development of scaffolds that specifically direct cellular differentiation, development of co-culture systems of multiple cell types on smart surfaces, development of vascularized constructs, reduction of serum dependence, and innervation into constructed muscle. The successful generation of functional muscle tissues requires an in-depth knowledge of both muscle tissue physiology and advanced engineering practices. The recent advances in tissue engineering technique and cell biology suggest that artificially-derived muscle constructs may be used in clinical settings in the near future.

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Feasibility of Neurovascular Antropylorus Perineal Transposition With Pudendal Nerve Anastomosis Following Anorectal Excision: A Cadaveric Study for Neoanal Reconstruction
Abhijit Chandra, Ashok Kumar, M Noushif, Nitish Gupta, Vijay Kumar, Navneet Kumar Chauhan, Vishal Gupta
Annals of Coloproctology.2013; 29(1): 7. CrossRef
Functional New Sphincter Ani Reconstruction by Using Neurovascualr Antropylorus Transposition After an Anorectal Excision
Bong Hwa Lee, Min Jung Kim, Hyoung Chul Park
Annals of Coloproctology.2013; 29(1): 5. CrossRef
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Journal of the Korean Surgical Society.2013; 84(4): 216. CrossRef

Original Article

Re-evaluation of the Clinical Significance of the Fatigue Rate Index in the External Anal Sphincter.: Seong, Moo Kyung , Shim, Jin Suk; J Korean Soc Coloproctol. 2009;25(2):75-80.; DOI: https://doi.org/10.3393/jksc.2009.25.2.75

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PURPOSE
The fatigue rate index (FRI) has been developed to access sustained voluntary contraction of the external anal sphincter. This study is designed to refine the technical aspects of measuring the FRI and to re-evaluate its clinical significance. METHODS: Thirty-eight patients with fecal incontinence (19 males, 19 females) and 37 (21 males, 16 females) controls were studied. Anal manometry was performed by using standard protocols. Fatigue was measured over a 20-sec squeeze at a high-pressure zone. The FRI was calculated from the maximum squeeze pressure (MXSP) and the fatigue rate. For the accuracy of the calculation, the mean resting pressure (MRP) was calibrated to zero before the metric procedure, representative segments of the calculation were selectively designated as those denoting sustained squeeze, and representative channels were designated from among 8 channels by using 3 or more of those showing typical sustaining-pressure curves. RESULTS: No difference in demographic factors was detected between the two groups. Basic manometric parameters were significantly different between the two groups (MRP, 29.4+/-21.3 vs. 44.4+/-17.8 mmHg, P=0.0015; MXSP, 205.9+/-98.0 vs. 274.2+/-106.5 mmHg, P=0.0051). The FRI was also significantly different (29.8+/-14.3 vs. 86.3+/-127.1 sec, P=0.0108). The areas under the receptor operating-characteristic curves for the MRP, the MXSP, and the FRI were 0.72, 0.69, and 0.84, respectively. The sensitivity and the specificity of the FRI for detecting fecal incontinence were 80% and 65% at 40 sec as a cut-off point. CONCLUSION: The FRI was proven to be more accurate than the MRP and the MXSP in detecting incontinence. With adequate modifications of the measuring method, measurement of the FRI could be done more easily and conveniently, but its cut-off point for detecting fecal incontinence was lower than previously reported.

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Anal sphincter fatigability in assessing anal incontinence: A systematic review
Dakshitha Wickramasinghe, Nilanka Wickramasinghe, Sohan Anjana Kamburugamuwa, Nandadeva Samarasekera, Janindra Warusavitarne, Carolynne Vaizey
Neurogastroenterology & Motility.2022;[Epub] CrossRef
Increased fatigability of external anal sphincter in inflammatory bowel disease: Significance in fecal urgency and incontinence
Athanasios A. Papathanasopoulos, Konstantinos H. Katsanos, Athina Tatsioni, Dimitrios K. Christodoulou, Epameinondas V. Tsianos
Journal of Crohn's and Colitis.2010; 4(5): 553. CrossRef
Effects of Age and Sex on Anorectal Manometry
Seung Chul Heo, Sung-Bum Kang, Kyu-Joo Park, Jae-Gahb Park
Journal of the Korean Society of Coloproctology.2009; 25(5): 285. CrossRef

Case Report

Management of the Symptoms after a Resection of the Rectum.: Lee, Sang Jeon; J Korean Soc Coloproctol. 2008;24(1):62-71.; DOI: https://doi.org/10.3393/jksc.2008.24.1.62

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Abstract PDF

Many patients have functional disturbances after a traditional restorative rectal resection, complaining of urgency, frequent bowel movements, and occasional fecal incontinence. The rectal reservoir function is disturbed, and this is related to the size of the rectal remnant and the elastic properties of the neorectal wall. A straight anastomosis is recommended when the reservoir capacity of the rectal remnant is sufficient. A side-to-end anastomosis is probably preferable to an end-to-end anastomosis. If a straight anastomosis is considered, the descending colon is much better than the sigmoid colon. If optimal functional results are to be obtained soon after surgery, construction of a pouch is recommended when the rectal remnant is very short. There seems to be a balance between continence without urgency and evacuation ability. For patients with weak sphincter muscles and habitually loose feces, the surgeon should tailor the length of the pouch to be longer whereas it should be made smaller for patients with a pre-operative tendency toward constipation. In the long-term, bowel adaptation may also enable the function after a straight anastomosis to approximate that of a colonic J-pouch anal anastomosis. Where the pelvis is too narrow for a bulky colonic J-pouch anal anastomosis, a coloplasty-anal- anastomosis is an option. The latter results in postoperative bowel function comparable with that of the colonic J-pouch. Traditionally, poor bowel function has been managed expectantly. The colonic adaptation may take one or two years to occur after a low anterior resection. The patient is advised to take adequate soluble fiber in the diet and to avoid foods which aggravate the bowel dysfunction. Those with increased stool frequency are prescribed constipating agents to help control the symptoms. Patients with rectal evacuation problems are prescribed regular laxatives and enemas.

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Quality of Life in Colorectal Cancer Patients according to the Severity of Symptom Clusters Classification
Gyeonghui Jeong, Kyunghee Kim, Yeunhee Kwak
Asian Oncology Nursing.2014; 14(2): 74. CrossRef

Reviews

Diagnosis and Management of Fecal Incontinence.: Seong, Moo Kyung; J Korean Soc Coloproctol. 2007;23(5):386-394.; DOI: https://doi.org/10.3393/jksc.2007.23.5.386

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Abstract PDF

Fecal incontinence is a common problem that is underreported, underdiagnosed and poorly managed. It profoundly affects the quality of life and psychological function. It is widely known that the diversity of causes of fecal incontinence and different modes of action of various treatment modalities mandates a tailored approach in each case. Currently, several diagnostic tests are available that can provide useful insights regarding the pathophysiology of fecal incontinence, and also several advanced treatment modalities which make it possible to rehabilitate most of these patients become recently available. Strictly speaking, however, no specific test can tell the exact etiology of fecal incontinence and the modes of action in various treatment modalities are still not well-defined. In this sense, policy of approach to patients with fecal incontinence can rather be straightforward. Patients with endosonographically proven sphincteric defect should be treated with sphincteroplasty. But for patients without such defect, less invasive procedures among recently available modalities should be the first consideration and then more invasive ones next in case of failure.

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Evaluation of Anal Continence Function by Advanced Anal Manometric Parameters
Moo-Kyung Seong, Keun-Young Kim, Young-Bum Yoo
Journal of the Korean Society of Coloproctology.2009; 25(1): 20. CrossRef

Evaluation and Treatment of Pelvic Floor Disorders.: Lee, Sang Jeon; J Korean Soc Coloproctol. 2007;23(3):206-220.; DOI: https://doi.org/10.3393/jksc.2007.23.3.206

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Abstract PDF: Pelvic floor disorders are of interest to many surgeons who specialize in organ systems within this region. Colorectal surgeons are especially interested in disorders of the posterior compartment, which may broadly be divided into defecation disorders and fecal incontinence. These disorders distress patients socially and psychologically and greatly impair their quality of life. The underlying anatomical and pathophysiological changes are complex, are often incompletely understood, and cannot always be determined. However, over the past decades, advances in the understanding of these disorders, together with rational methods of evaluation in anorectal physiology laboratories, radiology studies, and new surgical techniques, have led to promising results. This review summarizes the evaluation and treatment strategies, as well as the recent updates on the clinical and the therapeutic aspects of pelvic floor disorders.

Original Article

The Role of Rectoanal Inhibitory Reflex in the Anal Continence Function.: Seong, Moo Kyung , Yoon, Sang Nam , Park, Ung Chae , Hwang, Jae Kwan; J Korean Soc Coloproctol. 2007;23(2):75-79.; DOI: https://doi.org/10.3393/jksc.2007.23.2.75

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Abstract PDF: PURPOSE
The rectoanal inhibitory reflex (RAIR) aids the anal continence function by a sampling process. On the other hand, it might impair the anal continence function because the internal anal sphincter is relaxed during the reflex. We assessed the parameters of RAIR in incontinent patients with or without a sphincter defect and compared them with healthy control subjects to clarify the exact role of that reflex in the anal continence function.
METHODS
The recovery time, slope, amplitude, and area under the reflex curve of the RAIR were measured for 31 normal controls without any history of anorectal surgery (group A), 32 incontinent patients with a sphincter defect (group B), and 49 incontinent patients without a sphincter defect (group C). Incontinence was defined as bowel accidents of more than 3 by the Cleveland Clinic Florida score. A sphincteric defect was defined endoanal sonographically. The mean ages of group A, B, and C were 57.9+/-14.3, 54.5+/-13.6, and 61.8+/-15.4 years, respectively.
RESULTS
When group A and group B+C were compared, the recovery times (seconds) were 17.5+/-3.5 and 14.8+/-5.5 (P=.003), the slopes (mmHg/second) were 0.67+/-3.04 and 3.27+/-2.44 (P<.001), the amplitudes (%) were 7.0+/-16.5 and 53.3+/-19.4 (P=.352), and the area under the reflex curve (mmHg*seconds) were 230.2+/-102.15 and 173.0+/-140.8 (P=.020). When group B and group C were compared, the recovery times were 15.0+/-5.8 and 14.7+/-5.3 (P=.828), the slopes were 3.6+/-2.8 and 3.1+/-2.2 (P= .388), the amplitudes were 54.2+/-22.4 and 52.7+/-17.4 (P=.737), and the area under the reflex curve were 188.0+/-151.1 and 163.2+/-134.3 (P=.443). All parameters of the RAIR, except the amplitude were significantly diminished in incontinent patients whether they had a sphincter defect or not. CONSLUSIONS: Although the RAIR functions against continence in normal conditions by inhibiting sphincteric tone, it behaves suitably for keeping continence in the presence of incontinence, whatever the cause is, by attenuating the degree of inhibition.

Review

Present and Future in the Treatment of Fecal Incontinence.: Park, Duk Hoon; J Korean Soc Coloproctol. 2007;23(2):136-143.; DOI: https://doi.org/10.3393/jksc.2007.23.2.136

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Abstract PDF: Treatment of fecal incontinence still remains a challenge to modern medicine due to many specific sides of this problem. The diversity of causes of fecal incontinence and different modes of action of the various treatment modalities mandate a tailored, individualized approach in each case. Surgery is the last treatment modality for patients suffering from severe fecal incontinence. Recent studies have shown poor late results after primary sphincter repair and low predictive value for most preoperative diagnostic tests. New surgical options such as artificial devices and electrically stimulated muscle transpositions are reported by acceptable success rates and unacceptably frequent complications. That is why current attention has focused on non- or minimally invasive therapies such as sacral nerve stimulation and temperature-controlled radio-frequency energy delivery to the anal canal. However, all these innovative techniques remain experimental untill enough high- evidence data are gathered for their objective evaluation.

Original Article

Sphincter Repair for Fecal Incontinence after Obstetric Injury.: Ahn, Kwang Woo , Lee, Sang Jeon , Park, Jin Woo; J Korean Soc Coloproctol. 1999;15(1):9-19.

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Abstract PDF: PURPOSE
We designed this study to evaluate efficacy of sphincter repair and factors influencing in patients with postobstetric fecal incontinence.
METHODS
Twenty-one patients (mean age 42 years; range 23~67) undergoing sphincter repair for postobstetric fecal incontinence (mean duration 12 years; range 6 months~46 years) were evaluated prospectively. Preoperatively, standardized interviews, anorectal manometry and measurement of pudendal nerve terminal motor latency (PNTML) were performed. Incontinence was graded according to the Parks' classification: Grade 1 - continence to stool and flatus; Grade 2 - incontinent to flatus, some urgency to stool present but no incontinence; Grade 3 - incontinent to liquid stool; Grade 4 - incontinent to formed stool. Sphincter repair methods were overlap repair of external anal sphincter (EAS) in 4 patients, overlap repair of EAS with anterior levatorplasty in 15 patients, and overlap repair of EAS with anterior levatorplasty and postanal repair in 2 patients. Anorectal manometry at 3 months, and interviews at 3 months and 6 months after sphincter repair were performed again. Patients' satisfaction was classified as excellent, good, fair, and no improvement.
RESULTS
Difficulty in first delivery was noticed in 18 patients and history of previous sphincter repair was noticed in 5 patients. Preoperatively, most patients showed high grade incontinence (grade 3 in 13 and grade 4 in 8 patients). After sphincter repair, 18 patients (85.7%) became grade 1 or 2, and 16 patients (76.2%) replied their functional satisfaction excellent or good. There were no difference between the results at 3 months and 6 months. Poor functional outcome was in 2 of 3 patients with bilaterally prolonged preoperative PNTML. Short duration of incontinence and young age at the time of repair favored good results. Previous sphincter repair did not influence the outcome. Postoperatively both anal pressure and high pressure zone length were significantly increased in patients with improved continence Postoperative complications were wound infection in 2 patients and necrosis at the apex of the advancement skin flap in 1 case but these did not influence the outcome.
CONCLUSIONS
Most postobstetric fecal incontinence can be successfully treated with sphincter repair. Excellent results are expected when the duration of incontinence is short and the patients are young. Pudendal neuropathy seemed to be related to poor outcome.

Review

Artificial Bowel Sphincter for Fecal Incontinence.: Lee, Kil Yeon; J Korean Soc Coloproctol. 2006;22(5):350-355.

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Abstract PDF: Fecal incontinence is a common disorder, affecting all ages and both sexes. It is a devastating condition and has a major impact on quality of life. The level of treatment must be appropriate for the severity of symptoms. Nonsurgical techniques are appropriate for patients with minor degrees of incontinence. Patients with sphincter disruption or rectal prolapse can benefit from the appropriate surgical therapy. Patients with intractable, clinically significant fecal incontinence, caused by trauma or the failure of surgical therapy, need salvage options. In the past if a patient was not amenable to a tissue repair or failed a tissue repair, a colostomy was his or her only surgical option. However, new innovations can give patients more options to regain continence. The artificial bowel sphincter (ABS) is one of those newer options. It is an implantable device used to treat the patients with severe fecal incontinence, who have failed, or are not candidates for less invasive forms of restorative therapy. It is intended to mimic the natural process of bowel control. This device is reserved for patients with severe fecal incontinence that is not amenable to lesser forms of therapy. Because it is an artificial device, ABS is unfortunately associated with high morbidity and low success rate. With experience, however, the infection rate has declined due to new standardized prophylactic antibiotics regimen. Therefore, the ABS has become a good option for patients with severe fecal incontinence. The results are quite impressive with a significant number of patients obtaining complete continence. This review presents the technique of ABS implantation and the current status of ABS.

Original Articles

Outcome and Preoperative Predictive Factor after Complete Anatomical Repair in Perineal Obstetric Injury.: Park, Duk Hoon , Yoon, Seo Gue , Lee, Jong Ho , Yoon, Jong Seop , Rhou, Jai Hyun , Lee, Jong Kyun , Kim, Kwang Yun; J Korean Soc Coloproctol. 2002;18(4):222-228.

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Abstract PDF: PURPOSE
To assess the outcome of complete anatomical repair (sphincteroplasty, rectal wall plication, rectovaginal septum plication, perineal body repair, levatoroplasty) and to identify the preoperative factors influencing the outcome for the perineal obstetric injury.
METHODS
Eighteen, consecutive female patients who had undergone complete anatomical repair with chronic fecal incontinence due to perineal injury during 13 months were evaluated. Mean age was 48.9+/-10.1 years, mean duration of symptom was 18.9 (range: 1-33) years, mean delivery numbers were 2.8 +/-1.2 times, and mean follow up was 11.9 +/- 4.7 months. The predictive factors were age, manometry, PNTML (pudendal nerve terminal motor latency), rectal sensation, RAIR (rectoanal inhibitory reflex), duration of symptom, angle of sphincter defect, vaginal delivery numbers, hospital stay, follow-up period, wound healing period, and Wexner's incontinence score.
RESULTS
The anatomical success rate via endoanal ultrasonography was 100%, complication rate was 5.5%, and functional success rate (Wexners' score < or =5) was 88.9%. The patients showed lower maximal resting pressure, maximal squeezing pressure, maximal voluntary contraction, mean resting pressure, mean squeezing pressure, and maximal tolerable volume than the normal control group (p<0.05). The median incontinence score was significantly decreased after surgery (pre op=12.2 vs post op=2.9) (p<0.05). Among the preoperative predictive factors, the incontinence score correlated significantly with postoperative functional success (r=0.552, P=0.017).
CONCLUSIONS
Complete anatomical repair showed an excellent anatomical result and a good functional outcome. Patient with high preoperative incontinence score had a tendency for postoperative residual incontinence.

Measurement of External Anal Sphincter Function by Fatigue Rate Index.: Seong, Moo Kyung , Yoo, Young Bum; J Korean Soc Coloproctol. 2002;18(3):184-189.

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Abstract PDF: PURPOSE
Fatigue rate index (FRI) is one of relatively unknown parameters of anal manometry. It was devised to assess sustained voluntary contractibility of external anal sphincter muscle. We designed this study to determine the predictability of FRI in evaluating patients with symptoms of fecal incontinence.
METHODS
Consecutive male patients with fecal incontinence, those with prolapsed hemorrhoids but without any kind of incontinence symptom, and male healthy volunteers who have no anal symptom were grouped as A, B, C. Anal manometric parameters including FRI were measured and compared statistically among them.
RESULTS
All subjects were 84. Group A 27, Group B 33, and Group C 24. Their ages were 33.33+/-2.91 (mean SE), 39.27+/-2.80, and 50.81+/-4.33, respectively. Mean resting pressures (mmHg) were 78.11 6.56 for group A, 81.18+/-7.19 for group B, and 57.81+/-7.80 for group C. Maximum resting pressures (mmHg) were 98.67+/-9.69, 100.82+/-8.49, 78.13+/-10.26. Mean squeeze pressures (mmHg) were 229.11+/-18.72, 248.18+/-23.03, 156.94+/-17.89. Maximum squeeze pressures (mmHg) were 286.50+/-33.76, 298.59+/-27.83, 187.38+/-21.08. Resting radial asymmetries (%) were 18.85+/-2.81, 19.85+/-2.31, 28.70+/-4.79. Squeeze radial asymmetries were 15.73+/-2.90, 16.29+/-1.96, 16.47+/-2.95. Fatigue rates were 0.90+/-0.21, 1.17+/-0.15, 1.38+/-0.40. Fatigue rate indices (min.) were 3.76+/-0.41, 2.63+/-0.20, 1.94+/-0.26, respectively. Differences between group A and group C were statistically significant in mean squeeze pressure (P=0.0093), maximum squeeze pressure (P= 0.0190) and FRI (P=0.0008). Those between group B and group C were significant also in mean squeeze pressure (P=0.005), maximum squeeze pressure (P=0.0051), and FRI (P=0.0396). Multiple logistic regression analysis revealed that independently significant parameters were age (P= 0.002) and FRI (P=0.007). Cut-off point of FRI for incontinence with maximum sensitivity and specificity was 2.4min. by ROC (receiver operating characteristics) analysis.
CONCLUSION
FRI is a meaningful parameter in predicting fecal incontinence, which can be used in assessment of sphincter function and future treatment protocols.

Anorectal Physiology in the Rectal Prolapse Patient.: Son, Kyung Soo , Joo, Jae Sik , Wexner, Steven D; J Korean Soc Coloproctol. 1998;14(3):467-476.

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Abstract PDF: PURPOSE
The aim of our study was to evaluate the physiological spectrum of anorectal dysfunction among patients with full thickness circunferential rectal prolapse. MATERIAL AND METHODS: Between January 1988 and March 1995, 88 patients who visited department colorectal surgery, Cleveland Clinic Florida with rectal prolapse were studied. There were 8 males and 80 females, with a mean age 69 (range 28~101) years. Patients underwent a detailed history and the following anorectal physiology tests were performed: anal canal manometry, pudendal nerve terminal motor latency (PNTML) assessment, anal electromyography and cinedefecography.4 standard continence scoring system, based on the frequency and type of incontinence (0=full continence, 20=complete incontinence) was used. Patients with rectal prolapse (n=88) were divided into two subgroups: Group I=continent patients (n=33) and Group II= incontinent patients (n=55).
RESULTS
There were statistically significant differences between each group when comparing mean resting pressures, anal pressures, anal canal length, rectal compliance, rectoanal inhibitory reflex, increased fiber density, the occurrence of premature evacuation (p<0.001), and rectal capacity (p<0.05). However, dynamic changes of anorectal angle, resting anorectal angle, puborectalis length, and rectal sensitivity were not significantly different (p>0.05) between groups.
CONCLUSION
Continence may be disturbed in patients with rectal prolapse; knowledge of impairment in continence may assist in surgical management.

Clinical Significance of Amplitude in Pudendal Nerve Conduction Study in Patients with Defecation Disorders.: Joo, Jae Sik , Kim, Jae Do; J Korean Soc Coloproctol. 1998;14(2):241-246.

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Abstract PDF: Many different kinds of anorectal physiologic studies were performed for the evaluation of defecation disorders. Some of these studies are anorectal manometry and pudendal nerve conduction study. In pudendal nerve conduction study, pudendal nerve terminal motor latency (PNTML) was considered to be very useful for the evaluation and management of these patients. However, evaluation of amplitude in pudendal nerve conduction study has been clinically seldom used. Therefore, the aim of this study was to evaluate the clinical significane of amplitude in pudendal nerve conduction study in patients with defecation disorders by comparing to manometric profiles. MATERIAL AND METHODS: Between February, 1997 and February, 1998 all patients who underwent pudendal nerve conduction study and anorectal manometry for the evaluation of defecation disorders (constipation and fecalincontinence) were analyzed. Latency as well as amplitude in pudendal nerve conduction study were compared in both groups to the pressure profiles in manometric study according to the subgroups of these patients. Statistical analysis were performed by a Chi-square or Student's t-test and significance was assumed when p<0.05.
RESULTS
A total of 80 patients, forty constipation with a mean age of 55.3+/-14.5 (GI: range; 24~86) years and forty fecal incontinence with a mean age of 61.1+/-10.3 (GII: range; 37~74) years and a male to female ratio of 25:15 (GI), 28:12 (GII), were studied. PNTML in both sides in GI were significantly decreased in comparision to those of GII (GI: Rt, 2.17+/-0.7 ms Lt, 2.03+/-0.5 ms, GII: Rt, 2.50+/-0.7 ms, Lt 2.64+/-0.8 ms, p<0.05), However, there were no differences between the two groups in terms of amplitudes (GI: Rt 399.0+/-348 uV, Lt 426.8+/-403 uV, GII: Rt, 406.9+/-273 uV Lt, 392.9+/-291 uV, NS) in pudendal nerve conduction study. In manometric findings, even though maximal resting, mean, minimum and maximal pushing pressures were no differences in both groups, mean resting and maximal squeezing pressure were significantly increased in GI than those of GII (GI: 82.4+/-31 cmH20, GII: 60.5+/-25 cmH20 in mean resting pressure, GI: 213.1+/-108 cmH20, GII: 178.7+/-66 cmH20 in maximal squeezing pressure, p<0.05) When we analyzed the overall values of amplitudes according to the diagnosis, age, gender, and the value of PNTML, there were no statistically significant differences between the two groups. But, when the one side of PNTML shorter than the other side, it tended to have a high amplitude in that side than that of the other side in the same patient (the probability for trend was 74%).
CONCLUSION
Constipation patient has a shorter PNTML, higher mean resting, and maximal squeezing pressure than fecal incontinene patient. The amplitude in pudendal nerve conduction study had a trend of inverse correlation to the latency in the same patient. Therefore, amplitude in pudendal nerve conduction study might be useful to monitor or predict the outcome after treatment in patients with defecation disorders.

Predictors of Outcome Following Anterior Sphincter Repair in Obstetric Fecal Incontinence.: Lee, Sang Jeon; J Korean Soc Coloproctol. 2005;21(5):279-285.

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Abstract PDF: PURPOSE
This study was designed to evaluate the outcome of anterior sphincter repair and factors influencing the outcome in patients with obstetric fecal incontinence.
METHODS
Thirty-three patients undergoing sphincter repair for obstetric fecal incontinence were prospectively evaluated. Preoperatively, standardized interviews and physiologic studies were performed. The severity of incontinence was graded according to the Parks' classification. Patients' satisfaction was classified as excellent, good, fair, and no improvement. An anterior overlapping sphincteroplasty was performed with or without levatorplasty. Interviews and manometry were repeated three months after the operation. Four years after the operation, the severities of incontinence and patients' satisfaction were reevaluated.
RESULTS
Preoperatively, all patients showed high-grade incontinence (grade 3 or 4). Three months after the operation, 28 patients (84.8%) had successfully recovered continence (incontinence grade 1 or 2), and 25 of those patients (75.8%) replied with satisfaction (excellent or good). The maximal average squeeze pressure (MASP) and the high-pressure zone (HPZ) length, but not the maximal average resting pressure (MARP), had significantly increased in patients with successfully recovered continence. At the 4-year follow ups, the outcomes were significantly worse than thase at 3 months, but 24 patients (72.7%) still maintained good outcome, and 25 patients (66.7%) still replied with satisfaction that was not significantly worse than that at 3 months. Patients with a young age (<45 years), a shorter duration of incontinence (<10 years), a larger increase in MASP or MASP at 3 months after the operation, no pudendal neuropathy, and a good result at 3 months were more likely to maintain low-grade incontinence. The addition of levatorplasty and an increase in the HPZ length at 3 months did not affect the outcome.
CONCLUSIONS
At the 4-year follow-ups, the outcomes had significantly deteriorated, but patients' satisfaction had not. Age, the duration of incontinence, a postoperative increment in MASP or MASP, pudendal neuropathy, and a short-term good outcome were closely related to the long-term outcome.

Perineal Rectosigmoidectomy with Levatoroplasty for Rectal Prolapse Early functional outcome.: Yoon, Seo Gue , Lee, Jong Ho , Yoon, Jong Seob , Kim, Kuhn Uk , Kim, Hyun Shig , Lee, Jong Kyun , Kim, Kwang Yun; J Korean Soc Coloproctol. 2001;17(5):220-226.

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Abstract PDF: PURPOSE
This study was designed to analyze the short-term clinical and functional outcomes of perineal rectosigmoidectomy with levatoroplasty for complete rectal prolapse.
METHODS
The data were prospectively collected and consisted of the clinical data, the functional status before and after surgery, the operation record, and the postoperative course. The functional status was evaluated by using Wexner's constipation score (0-30), Wexner's incontinence score (0-20), anorectal manometry, and pudendal nerve terminal motor latency. Follow-up was performed at 3-6 months after the operation by using both a standardized questionnaire completed in the outpatient clinic or telephone interview (n=23) and an anorectal physiology test (n=7).
RESULTS
During a one-year period, 23 patients (male=10) underwent perineal rectosigmoidectomy with levatoroplasty for complete rectal prolapse. The median duration of the operations was 88 minutes. The median length of postoperative hospital stay was 6 days. There was one urinary tract infection and no mortalities. The constipation score was significantly decreased after the operation (9.8 vs 3.8; P<0.001), and constipation was improved in 90 percent (19/21) of the cases. The incontinence score was significantly decreased after surgery (mean preop.=11.6, postop.=3.7; P<0.001) and incontinence was improved in 17 of 21 patients with impaired continence (81 percent). Anal sphincter function was not improved but rectal reservoir capacity was significantly decreased after surgery (rectal urgent volume (45.7 cc vs 37.1 cc; P=0.045), maximal tolerable volume (120 cc vs 85.7; P=0.011). Most patients (83 percent) felt that the operation had improved their symptoms. The major reasons for dissatisfaction after surgery were frequent defecation, fecal soiling, persistent or aggravated fecal incontinence, and recurrence. One patient had a complete recurrence (4.3 percent), and another patient had a mucosal prolapse which was treated.
CONCLUSIONS
Perineal rectosigmoidectomy with levatoroplasty for complete rectal prolapse is a safe technique with acceptable short-term functional results; however, it is not recommended for rectal prolapse patients with diarrhea-predominant irritable bowel syndrome.

Effect of Biofeedback Treatment in Patients with Fecal Incontinence.: Park, In Ja , Yu, Chang Sik , Kim, Hee Cheol , Jung, Young Hak , Han, Kyong Rok , Park, Sang Kyu , Kim, Jung Rang , Song, Jin Sook , Lee, Hyang Ran , Kim, Jin Cheon; J Korean Soc Coloproctol. 2005;21(3):138-144.

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Abstract PDF: PURPOSE
We aimed to assess the efficacy of biofeedback therapy for patients with fecal incontinence (FI) according to the etiology.
METHODS
Twenty-nine patients with fecal incontinence were treated with biofeedback therapy using a EMG-based system. The efficacy was assessed by using changes in the FI score (Cleveland Clinic, Florida: 0~20) and satisfaction based on a subjective evaluation score from 0 to 100. The median follow up duration was 12 (3~25) months.
RESULTS
Ten patients had idiopathic fecal incontinence. Fourteen patients had fecal incontinence due to a sphincter saving operation for rectal cancer. Four cases had spinal cord injury and one patient had a major external sphincter tearing due to trauma. The mean age was 52 (16~78) years. The median number of biofeedback sessions was 10 (3~15) overall. The mean efficacy was 42.8%, and the mean satisfaction score was 56.6. Improvements in the FI score and in the patients' satisfaction varied according to the etiology, 69.5% and 71.5 in the idiopathic group, 28.5% and 49.3 in the postoperative group, and 35% and 24 in the spinal cord injury group. In the idiopathic group, 50% of the patients showed an improvement in the FI score of more than 75%, and 90% of the patients showed an improvement of more than 50%. The number of liquid incontinence episodes was improved 78.3% later in the biofeedback group, and this result was much better than in the postoperative incontinence group (31.8%, p=0.03).
CONCLUSIONS
The success rate of the biofeedback therapy for fecal incontinence is acceptable. Subjective satisfaction is relatively higher than the improvement in the ecal incontinence score. Idiopathic fecal incontinence may be the best indication for biofeedback therapy.

Defecographic Findings in Patients with Fecal Incontinence.: Park, Hyo Jin , Jung, Jun Keun , Shin, Jae Ho , Lee, Sang In , Park, In Suh; J Korean Soc Coloproctol. 1997;13(4):591-596.

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Abstract PDF: We performed this study to investigate defecographic findings in patients with fecal incontinence and to compare these findings with age-matched asymptomatic controls. Twenty patients with fecal incontinence and 20 asymptomatic subjects were included. Videodefecography and pelvic electrophysiologic test were performed. There were no significant differences on the presence of rectal wall changes such as rectocele, mucosal prolapse, or incomplete evacuation, but intussusception was more common in patients group. The anorectal angle were 112.8+/-16.2degrees, 93.0+/-15.0degrees, 118.8+/-16.3degrees at resting, squeezing, and straining, respectively in controls, whereas 121.5+/-20.8degrees, 110.8+/-22.2degrees, 132.0+/-21.1degrees, respectively in patients group. There were significant differences of anorectal angle at squeezing and straining in patients group compared with controls(p< 0.05). Perineal descent was significantly decreased at squeezing in patients group compared with controls(p<0.05). Anal canal width was signi(icantly widened in patients group compared with controls(p<0.05). There were no differences in various defecographic parameters depending on the presence of pudendal neuropathy. In conclusion, defecographic findings in fecal incontinence showed more obtuse anorectal angle, poorer perineal descent at squeezing, and widening of anal canal.

Can We Predict the Severity of Fecal Incontinence by Preoperative Physiologic.: Joo, Jae Sik , Son, Sang Ho , Han, Jung Ki , Son, Kyung Soo , Sung, Sang Young; J Korean Soc Coloproctol. 1997;13(4):583-590.

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Abstract PDF: Many kinds of different treatment options for fecal incontinence such as biofeedback therapy, anterior or posterior sphincteroplasty, pelvic floor repair, gracilis or gluteus muscle transposition have been introduced. However, appropriate indications for these treatment options have not yet been delineated up to now. PURPOSE: The aim of this study was to access the preoperative severity of fecal incontinence by physiologic tests to give an idea that indications of appropriate selection criteria and parameters for assess the outcome could be simultaneously considered by preoperatively objective physiologic data. MATERIALS AND METHODS: From January 3, 1997 to, August 1, 1997 all patients with fecal incontinence who visited colorectal clinic in the Department of Surgery, Korea Veterans Hospital, were classified into two groups according to the severity of fecal incontinence (0~20): Group I (1~9), Group II (10~20) and compared them with the results of physiologic tests: anorectal manometry, endorectal ultrasound (ERU), cinedefecography, and pudendal nerve terminal motor latency (PNTML). Statistical analysis was performed by Student's-t test, and Chi-square test and p<0.05 was considered significant.
RESULTS
The number of GI was 25, and GII was 22. There were no differences between the two groups in terms of age (GI: 57.7+/-14.5, GII: 61.4+/-14.0years), gender (male: female, 19:6, 16:6), cause (neurogenic; 11/25 (GI),7/22(GII), postanal surgery; 6/25,6/22) obstetric trauma (2/25, 2/22), anal trauma (1/25, 1/22) diabetes melitus (1/25, 2/22), rectal prolapse (2/25, 1/22), and others (2/25, 3/22), duration of fecal incontinence (64.4+/-82.2, 48.7+/-65.3 months), high pressure zone (3.3+/-1.7, 3.5+/-1.4 cm), mean resting pressure (50.5+/-27.0, 51.9+/-18.7 cm H2O), maximal resting pressure (88.4+/-50.6, 89.4+/-41.8 cm), maximal squeezing pressure (150.6+/-71.0, 129.7+/-59.5 cm H2O), rectoanal inhibitatory reflex (13/21, 8/21 positive), sensitivity (37.5+/-15.2, 41.8+/-29.0 cc), compliance (19.0+/-14.5, 21.4+/-39.4 cc/cm H2O) in anorectal manometric findings, anal sphincter defect (13/21, 15/22 positive), size of defect (60+/-26.30degrees, 71 +/-30.8degrees/360degrees), thickness of the external anal sphincter (3.46+/-0.78, 3.84 +/-1.02 cm), thickness of internal anal sphincter (1.58+/-0.79, 1.74+/-0.81 cm) in ERU, anorectal angle in rest (85.2+/-28.0degrees, 97+/-22.9degrees), squeeze (72+/-27.1degrees, 82 +/-19.7degrees), push (100+/-43.9degrees, 117.9+/-34.5degrees), length of perineal descent in rest (3.7+/-1.2, 3.6+/-1.7 cm), squeeze (2.9+/-1.5, 2.7+/-1.5 cm), push (7.9+/-3.5, 6.6+/-2.6 cm) in cinedefecography. However, rectal capacity in manometry (212.5+/-99.9, 155+/-51.5 cc, p<0.05), right PNTML (1.73+/-0.39, 2.71+/-0.83 ms, p<0.001), and left PNTML (1.83+/-0.43, 2.94+/-0.80 ms, p<0.001) were significantly increased in GII compare to those of GI.
CONCLUSION
As the severity of fecal incontinence was increased, rectal capacity, right and, left PNTML were increased.

Factors Influencing Fecal Incontinence in Complete Rectal Prolapse: A Prospective Analysis.: Yoon, Seo Gue , Lee, Kwang Real , Kim, Khun Uk , Song, Seok Kyu , Kim, Chil Seok , Lee, Jong Kyun , Kim, Kwang Yun; J Korean Soc Coloproctol. 2001;17(1):7-14.

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Abstract PDF: PURPOSE
This study was undertaken to identify factors influencing fecal incontinence in rectal prolapse.
METHODS
The clinical and anorectal physiologic data (anal manometry, rectal sensitivity test, pudendal nerve terminal motor latency (PNTML)) of 42 complete rectal prolapse patients were collected in a prospective database and were analyzed according to Wexner's incontinence score (0-20).
RESULTS
The mean Wexner's incontinence score was 10.6. Females (n=24) were more prone to be incontinent than males (n=18)(incontinence score 14.8 vs 5.1, p<0.001). A linear regression analysis showed that increased age (r= 0.497, p=0.001), decreased maximum resting pressure (MRP) (r= 0.686, p<0.001), decreased maximum squeezing pressure (MSP)(r= 0.789, p<0.001), decreased maximal rectal tolerable volume (MTV) (r= 0.386, p=0.012) influenced the incontinence score. An absent rectoanal inhibitory reflex (RAIR) was not related to incontinence, but was related to significantly low resting anal pressure. Delayed PNTML did not influence incontinence or the MSP. In a multiple regression analysis, decreased MRP (beta= 0.383; p=0.002), decreased MSP (beta= 0.345; p =0.007) and female gender (beta=0.343; p=0.006) influenced incontinence significantly.
CONCLUSIONS
Major factors influencing fecal incontinence in complete rectal prolapse were decreased MRP and MSP. Female patients were more prone to fecal incontinence than males. RAIR and MTV were not significant factors. PNTML did not show any relation to incontinence score or the anal pressure.

Gluteus Maximus Transposition for Anal Incontinence.: Chang, Ji Young , Kim, Cheong Tong , Kim, Kweon Cheon , Min, Young Don; J Korean Soc Coloproctol. 1997;13(1):137-144.

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Abstract PDF: Anal incontinence following pelvic trauma, surgery or neurologic disorder has significant medical and social implications. When no known functioning sphincter muscles are present, surgical correction of this distressing condition other than by stomal fecal diversion is aimed at recreating a sphincter mechanism under voluntary control. The use of the gluteus maximus encircling the neorectum with a contractile muscualr ring provides an active control of continence and reserves the anorectal angulation. The sacrifice of the entire gluteus maximum muscle in an ambulatory patient will cause difficulty in climbing stairs; however, the use of the anatomically dissected lower half will preserve its function. With careful dissection, the lower half of the g1uteus maximus muscle together with its neurovascular supply can be developed for anal sphincter reconstruction. Three Patient, (two men and one woman) underwent g1uteus maximus transposition for complete anal incontinence. The indication for operation were sphincter destruction secondary to extensive soft tissue necrosis on perianal, perineal and buttock area due to necrotizing fascitis(n=2), and soft tissue defect on perianal, buttock area due to trauma(n=1). The procedure is performed with the use of a diverting colostomy. The inferior portion of the origin of each gluteus maximus is detached from the sacrum and coccyx, bifurcated,and tunneled subcutaneously to encircle the anus. The ends were sutured together to form two opposing slings of voluntary muscles. Postoperatively two patient regained continence to solid stool, one to liquid stool as well. The technique of constructing sphincter is simple and utilizes principles of muscle tendon transfer without jeopardizing function of gait. Furthermore the gluteus maximus muscle, being an accessory muscle of anal continence, is an ideal structure for this reconstruction.

Clinical and Physiologic Characteristics of Rectal Prolapse in Males.: Yoon, Seo Gue , Lee, Kwang Real , Cho, Kyung A , Hwang, Do Yean , Kim, Khun Uk , Kang, Young Won , Park, Weon Kap , Kim, Hyun Sik , Lee, Jung Kyun , Kim, Kwang Yun; J Korean Soc Coloproctol. 2000;16(4):223-230.

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Abstract PDF: This study compares the sexual differences among rectal prolapse patients regarding the clinical and the physiologic characteristics with emphasis on males.
METHODS
The clinical data, functional status and operative records of 43 patients, who had completed both clinical and functional evaluations were collected in a prospective database and were analyzed according to sex. The functional status of the patients was evaluated by Wexner's constipation score (0~30), Wexner's incontinence score (0~20), anorectal manometry, and pudendal nerve terminal motor latency (PNTML).
RESULTS
The incidences of rectal prolapse in males (n=22) and in females (n=21) were similar. The age of onset for males was lower (mean standard deviation, 19.6 19.59 (50% in childhood) vs 52.0 20.75 years; p=0.001) and the duration of symptoms was longer (31.5+/-19.87 vs 12.5+/-14.31 years; p<0.001). Surgery in males was most commonly performed during the sexually active years (51.2+/-16.34 vs 64.5+/-13.19; p=0.006). The incidence of mucosal prolapse in males was higher (10/22 vs 4/17; p=0.065). The incidences and the severities of defecation difficulty in males and females were similar (n=12, mean Wexner score=8.4 vs n=12, mean Wexner score=9.9; p=NS) but, the incidences and the severities of fecal incontinence were lower in males (n=4, mean Wexner score=4.3 vs n=17, mean Wexner score= 14.2; p<0.001). The maximum resting pressure was higher in males (39.2+/-21.46 vs 26.3+/-19.98 mmHg; p=0.049), and the maximum squeezing pressure was better preserved (131.2+/-62.63 vs 67.5+/-37.99 mmHg; p<0.001). No significant difference existed in the PNTML. Female patients underwent abdominal resection rectopexy (n=6), perineal rectosigmoidectomy with lavatoroplasty (n=11), and Delorme's procedure (n=4), but all male patients preferred the perineal approach (rectosigmoidectomy with lavatoroplasty (n=8), Delorme's procedure (n=14)) for fear of sexual dysfunction after the abdominal approach.
CONCLUSIONS
These findings suggest that the mechanism for developing rectal prolapse in male and female may be different and that surgical treatment should be tailored to the patient.

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