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Anefalos A, Martinez CAR, Coy CSR. London Protocol under water-perfused HRM in a healthy population, towards novel 3D manometric parameters in an evaluation of anorectal functional disorders. BMC Gastroenterol 2024; 24:127. [PMID: 38575859 PMCID: PMC10996243 DOI: 10.1186/s12876-024-03207-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Accepted: 03/18/2024] [Indexed: 04/06/2024] Open
Abstract
BACKGROUND/AIM London Protocol (LP) and Classification allied to high-resolution manometry (HRM) technological evolution has updated and enhanced the diagnostic armamentarium in anorectal disorders. This study aims to evaluate LP reproducibility under water-perfused HRM, provide normal data and new parameters based on 3D and healthy comparison studies under perfusional HRM. METHODS Fifty healthy (25 F) underwent water-perfused 36 channel HRM based on LP at resting, squeeze, cough, push, and rectal sensory. Additional 3D manometric parameters were: pressure-volume (PV) 104mmHg2.cm (resting, short and long squeeze, cough); highest and lowest pressure asymmetry (resting, short squeeze, and cough). Complementary parameters (CP) were: resting (mean pressure, functional anal canal length); short squeeze (mean and maximum absolute squeeze pressure), endurance (fatigue rate, fatigue rate index, capacity to sustain); cough (anorectal gradient pressure); push (rectum-anal gradient pressure, anal canal relaxation percent); recto-anal inhibitory reflex (anal canal relaxation percent). RESULTS No difference to genders: resting (LP, CP, and 3D); short squeeze (highest pressure asymmetry); endurance (CP); cough (CP, highest and lowest pressure asymmetry); push (gradient pressure); rectal sensory. Higher pressure in men: short squeeze (maximum incremental, absolute, and mean pressure, PV, lowest pressure asymmetry); long squeeze (PV); cough (anal canal and rectum maximum pressure, anal canal PV); push (anal canal and rectum maximum pressure). Anal canal relaxation was higher in women (push). CONCLUSIONS LP reproducibility is feasible under water-perfused HRM, and comparative studies could bring similarity to dataset expansion. Novel 3D parameters need further studies with healthy and larger data to be validated and for disease comparisons. KEY POINTS • London Protocol and Classification allied with the technological evolution of HRM (software and probes) has refined the diagnostic armamentarium in anorectal disorders. • Novel 3D and deepening the analysis of manometric parameters before the London Classification as a contributory diagnostic tool. • Comparison of healthy volunteers according to the London Protocol under a perfusional high-resolution system could establish equivalence points.
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Affiliation(s)
- Alexandre Anefalos
- Department of Surgery, FCM, State University of Campinas-UNICAMP, Campinas, SP, Brazil.
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Ximenes RRC, Chaves EMC, Girão ALA, Gonçalves MHRB, Ferreira SL, de Carvalho REFL. Knowledge of nursing staff before and after training on incontinence-associated dermatitis. Rev Esc Enferm USP 2024; 58:e20230272. [PMID: 38558025 PMCID: PMC11021019 DOI: 10.1590/1980-220x-reeusp-2023-0272en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 01/31/2024] [Indexed: 04/04/2024] Open
Abstract
OBJECTIVE To verify the knowledge of nursing staff before and after training on incontinence-associated dermatitis. METHOD A study before and after an educational intervention carried out with nursing staff from the medical and surgical clinics and intensive care unit of the university hospital in June 2023. The training took place over three meetings. Data was collected using a questionnaire administered immediately before and after the training. McNemar's test for dependent samples was used to compare before and after training. RESULTS 25 nurses and 14 nursing technicians took part. The items that showed statistical significance were related to the identification and correct differentiation of dermatitis associated with incontinence and pressure injury; and the correct way to sanitize the skin. CONCLUSION The training of the nursing team made it possible to assess their knowledge of how to identify, prevent and treat incontinence-associated dermatitis.
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Affiliation(s)
- Raelly Ramos Campos Ximenes
- Universidade Estadual do Ceará, Programa de Pós-Graduação em Cuidados Clínicos em Enfermagem e Saúde, Fortaleza, CE, Brazil
| | - Edna Maria Camelo Chaves
- Universidade Estadual do Ceará, Programa de Pós-Graduação em Cuidados Clínicos em Enfermagem e Saúde, Fortaleza, CE, Brazil
| | | | | | - Saionara Leal Ferreira
- Universidade Federal do Ceará, Hospital Universitário Walter Cantídio, Fortaleza, CE, Brazil
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Wynn J, Kelsey E, McLeod K. Treatment of the infected sacral nerve stimulator: A scoping review. Neurourol Urodyn 2024; 43:579-594. [PMID: 38318878 DOI: 10.1002/nau.25411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 01/13/2024] [Accepted: 01/24/2024] [Indexed: 02/07/2024]
Abstract
BACKGROUND Sacral nerve stimulators (SNSs) are a widely accepted, efficacious surgical option to treat patients who have failed conservative management for overactive bladder, nonobstructive urinary retention, fecal incontinence, or pelvic pain. As with all implanted devices, there are associated risks for surgical site and implant infections. There are currently no clear published data or guidelines regarding treating such infections. AIMS We present a scoping review aiming to examine the existing literature on the treatment approaches of infected SNSs. METHODS A scoping review was conducted using Preferred Reporting Items for Systematic Review and Meta-Analysis. The search strategy focused on "sacral modulation," and "infection," and "explantation," and conservative management methods such as "antibiotics." A search was conducted on medical databases, and a grey literature search was performed. RESULTS Thirty articles were included for data extraction. Articles were published between 2006 and 2022. Outcomes were reported for 7446 patients. Two hundred and seventy-four infection events were reported, giving an overall 3.7% infection rate. Most infection events were treated with explantation, although there is some discussion on the role of conservative management using oral and intravenous antibiotics in the literature. Articles also discussed considerations for future reimplantation after explantation of SNS. CONCLUSIONS There are currently no treatment protocols in the literature to help guide whether a patient is suited to conservative or surgical management. There is future scope for developing treatment algorithms to guide clinicians for optimal treatment of infected sacral neuromodulation devices.
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Affiliation(s)
- Jessica Wynn
- Department of Urology, University Hospital Geelong, Barwon Health, Geelong, Australia
| | - Ellen Kelsey
- Department of Urology, University Hospital Geelong, Barwon Health, Geelong, Australia
| | - Kathryn McLeod
- Department of Urology, University Hospital Geelong, Barwon Health, Geelong, Australia
- Faculty of Health, Deakin University School of Medicine, Geelong, Australia
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Yu Z, Su X. Clinical study of electro-coagulation tunneling method based on oligopolistic technique for the treatment of low single anal fistula. Asian J Surg 2024; 47:1182-1183. [PMID: 37973479 DOI: 10.1016/j.asjsur.2023.11.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 11/03/2023] [Indexed: 11/19/2023] Open
Affiliation(s)
- Zhihan Yu
- Department of Plastic Surgery, Dalian University Affiliated Xinhua Hospital, Dalian, 116021, China
| | - Xiaowei Su
- Department of Plastic Surgery, Dalian University Affiliated Xinhua Hospital, Dalian, 116021, China.
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den Hollander VEC, Trzpis M, Broens PMA. The contribution of descending intramural nerves to regulation of anal sensibility: new insights for anorectal surgery. Br J Surg 2024; 111:znad439. [PMID: 38265811 DOI: 10.1093/bjs/znad439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 10/19/2023] [Accepted: 10/20/2023] [Indexed: 01/25/2024]
Affiliation(s)
- Venla E C den Hollander
- Department of Surgery, Anorectal Physiology Laboratory, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Monika Trzpis
- Department of Surgery, Anorectal Physiology Laboratory, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Paul M A Broens
- Department of Surgery, Anorectal Physiology Laboratory, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Department of Surgery, Division of Pediatric Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Wang C, Ishizuka T, Tanaka M, Matsuo K, Knight H, Harvey N, Gillespie-Akar L, Gibble TH. Bowel Urgency in Patients with Ulcerative Colitis and Crohn's Disease: A Cross-Sectional Real-World Survey in Japan. Adv Ther 2024; 41:431-450. [PMID: 37999831 PMCID: PMC10796472 DOI: 10.1007/s12325-023-02726-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 10/31/2023] [Indexed: 11/25/2023]
Abstract
INTRODUCTION Bowel urgency (BU) is among the most disruptive of inflammatory bowel disease (IBD) symptoms. However, data on its prevalence and association with disease activity are limited. This real-world study of Japanese patients with IBD evaluated BU prevalence and compared clinical outcomes and health-related quality of life (HRQoL) between patients with and without BU. METHODS Data were drawn from the Adelphi IBD Disease Specific Programme™, a cross-sectional survey of physicians and their patients with ulcerative colitis (UC) and Crohn's disease (CD). Physicians reported demographic and clinical data, including disease activity measures (Mayo score and CD Activity Index [CDAI]), for consulting patients, who voluntarily completed a patient-reported questionnaire, including HRQoL measures (Short IBD Questionnaire [SIBDQ] and EQ-5D-5L). Outcomes were compared between patients with and without BU using t-, Fisher exact and Mann-Whitney U tests as appropriate. RESULTS Of 120 UC patients, 27.5% (n = 33) self-reported BU; physicians were unaware of BU in 54.5% (n = 18) of these patients. Patients with BU had higher mean Mayo scores (p < 0.01) and lower mean SIBDQ scores (47.9 vs 56.6, p < 0.01) than patients without BU, with mean EQ-5D-5L scores 0.83 and 0.87, respectively (p = 0.06). Physicians were satisfied with treatment but believed better control could be achieved for 39.4% of patients with BU and 35.6% without. Of 114 CD patients, 17.5% (n = 20) self-reported BU; physicians were unaware of BU in 75.0% (n = 15) of these patients. Patients with BU had higher mean CDAI scores (p < 0.01) and lower mean SIBDQ (48.7 vs 56.2, p < 0.01) and EQ-5D-5L scores (0.81 vs 0.88, p < 0.01) than patients without BU. Physicians were satisfied but believed better control could be achieved for 40.0% of patients with BU vs 19.1% without. CONCLUSIONS Patients with BU have worse clinical outcomes and HRQoL than patients without, underlining the need for improved physician-patient communication regarding BU and new IBD therapeutic options.
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Dawoud C, Gidl D, Widmann KM, Pereyra D, Harpain F, Kama B, Riss S. Endosonographic monitoring of Sphinkeeper ® prostheses movements: does physical activity have an impact? Updates Surg 2024; 76:169-177. [PMID: 37640968 PMCID: PMC10805872 DOI: 10.1007/s13304-023-01636-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 08/16/2023] [Indexed: 08/31/2023]
Abstract
The Sphinkeeper® procedure for treating faecal incontinence (FI) may be associated with potential implant migration (IM) and dislocation (ID), with considerable variations regarding their occurrence and effects on consecutive functional outcome. This study assessed IM and ID following the Sphinkeeper® procedure and its correlation with physical activity. This was a prospective observational clinical study of ten patients undergoing Sphinkeeper® operation due to FI between August 2020 and November 2020 at the Medical University of Vienna. Patients were followed-up after 1, 2, 3 and 6 months and 1 year postoperatively. Each follow-up visit included endosonographic monitoring of protheses location and manometric examinations. Additionally, functional outcome and physical activity were assessed using validated standardized questionnaires. The median number of prostheses implanted was 10 (IQR 9-10). The St. Mark's incontinence (SMS) score improved significantly until the last follow-up (p = 0.049), without observing a significant effect on the physical SF-12 score. The median rate of implants leading to IM and ID was 3 (range 1-4) and 2 (range 1-2) after 3 months of follow-up. A strong association of deltaSMS with number of dislocated prostheses at one month after Sphinkeeper® implantation was observed (r = 0.654, p = 0.078). Physical activity, assessed by the international physical activity questionnaire, did not have an impact on the correct prosthesis placement (1 month: p = 0.527; 2 months: p = 0.886; 3 months: p = 0.180; 6 months: p = 0.111). IM and ID of Sphinkeeper® prostheses occurred frequently early after surgery and affected functional outcome negatively. Physical activity did not have an influence on the implants displacement.
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Affiliation(s)
- Christopher Dawoud
- Division of Visceral Surgery, Department of General Surgery, Medical University Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Daniel Gidl
- Division of Visceral Surgery, Department of General Surgery, Medical University Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Kerstin Melanie Widmann
- Division of Visceral Surgery, Department of General Surgery, Medical University Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - David Pereyra
- Division of Visceral Surgery, Department of General Surgery, Medical University Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Felix Harpain
- Division of Visceral Surgery, Department of General Surgery, Medical University Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Berfin Kama
- Division of Visceral Surgery, Department of General Surgery, Medical University Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Stefan Riss
- Division of Visceral Surgery, Department of General Surgery, Medical University Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
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Anorectal Branch of Chinese Medical Doctor Association, Clinical Guidelines Committee of Anorectal Branch of Chinese Medical Doctor Association, Anorectal Motility Disorders Committee of Colorectal Surgeons Branch of Chinese Medical Doctor Association, Colorectal Branch of China International Exchange and Promotive Association for Medical and Healthcare. [Chinese expert consensus on colonic and anorectal manometry (2023 edition)]. Zhonghua Wei Chang Wai Ke Za Zhi 2023; 26:1095-102. [PMID: 38110269 DOI: 10.3760/cma.j.cn441530-20230922-00102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 12/20/2023]
Abstract
Colonic and anorectal manometry includes anorectal manometry and colonic manometry. Anorectal manometry is a common method to evaluate anorectal function, which can objectively reflect the pathological and physiological abnormalities of outlet obstructive constipation and fecal incontinence, as well as the impact of anorectal surgery on continence. Colonic manometry is a new type of colon motility detection method developed in recent years. It can record the peristalsis and contraction of the whole colon through a pressure measuring catheter, which helps physicians further evaluate various colonic diseases. However, various factors such as testing equipment, operating standards, and evaluation parameters are difficult to unify. There is no consensus on the operation and interpretation of colorectal anal pressure measurement. Under the guidance of the Anorectal Branch of Chinese Medical Doctor Association, in collaboration with Clinical Guidelines Committee, Anorectal Branch of Chinese Medical Doctor Association, Anorectal motility disorders Committee , Colorectal Surgeons Branch of Chinese Medical Doctor Association, Colonic Branch of China international exchange and promotive association for medical and healthcare, Tianjin Union Medical Center is leading the organization of domestic experts in this field. Based on searching relevant literature and combining clinical experience at home and abroad, after multiple discussions, the "Chinese expert consensus on colonic and anorectal manometry" has been prepared. This consensus discusses the indications, contraindications, pre examination management and technical procedures, treatment of complications, and interpretation of examination reports for colonic and anorectal manometry , aiming to guide the standardized clinical practice of colonic and anorectal manometry.
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He J, Zhou MD, Wu WJ, Liu ZY, Wang D, Yang GG, Yang QY, Shen Z. The comparison of an accessible C-shaped partial stapled hemorrhoidopexy (C-PSH) versus circular stapled hemorrhoidopexy (CSH) in patients with grade IV hemorrhoids: a retrospective cohort study. BMC Gastroenterol 2023; 23:443. [PMID: 38104065 PMCID: PMC10725019 DOI: 10.1186/s12876-023-03062-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 11/24/2023] [Indexed: 12/19/2023] Open
Abstract
OBJECTIVES The objectives of this study were to present an accessible C-shaped partial stapled hemorrhoidopexy (C-PSH) in the treatment of grade IV hemorrhoids and to assess long-term outcomes of this technique compared with circular stapled hemorrhoidopexy (CSH). METHODS Conventional CSH kits combined with an intestinal spatula were used for performing C-PSH. A total of 256 patients with grade IV hemorrhoids referred to Hangzhou Third People's Hospital between January 2016 and June 2017 were obtained: 122 (47.7%) with C-PSH, and 134 (52.3%) with CSH. After propensity score matching, 222 patients (111 in C-PSH group and 111 in CSH group) were ultimately analyzed. The primary outcome was the five-year recurrence rate of hemorrhoids. Secondary outcomes included intraoperative outcomes, postoperative outcomes and complications. RESULTS The operative time in the C-PSH group was slightly longer than that in the CSH group (p < 0.01). The vertical length of rectal mucosa specimen in the C-PSH group was shorter than that in the CSH group (p < 0.01). Compared with the CSH group, fecal urgency incidence and numeric rating scale (NRS) score at first defecation were lower in the C-PSH group (p < 0.05). Major complication rate in the CSH group was higher than that in the C-PSH group (p = 0.03). Five-year recurrence rate between the C-PSH group and CSH group was comparable (p > 0.05). Multivariate Cox regression analysis revealed that constipation was an independent prognostic factor for hemorrhoidal recurrence. CONCLUSIONS The accessible C-PSH seems to be a safe and effective technique in managing grade IV hemorrhoids. It has advantages in alleviating postoperative pain at first defecation, fecal urgency and major complications compared with CSH. It could be an alternative technique in the treatment of grade IV hemorrhoids.
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Affiliation(s)
- Jun He
- Department of Colorectal Surgery, Hangzhou Third People's Hospital, Hangzhou, 310009, Zhejiang, People's Republic of China
| | - Meng-Dan Zhou
- Department of Nursing, Hangzhou First People's Hospital, Hangzhou, 310006, Zhejiang, People's Republic of China
| | - Wen-Jing Wu
- Department of Colorectal Surgery, Hangzhou Third People's Hospital, Hangzhou, 310009, Zhejiang, People's Republic of China
| | - Zhi-Yong Liu
- Department of Colorectal Surgery, Hangzhou Third People's Hospital, Hangzhou, 310009, Zhejiang, People's Republic of China
| | - Dong Wang
- Department of Colorectal Surgery, Hangzhou Third People's Hospital, Hangzhou, 310009, Zhejiang, People's Republic of China
| | - Guan-Gen Yang
- Department of Colorectal Surgery, Hangzhou Third People's Hospital, Hangzhou, 310009, Zhejiang, People's Republic of China
| | - Qin-Yan Yang
- Department of Colorectal Surgery, Hangzhou Third People's Hospital, Hangzhou, 310009, Zhejiang, People's Republic of China.
| | - Zhong Shen
- Department of Colorectal Surgery, Hangzhou Third People's Hospital, Hangzhou, 310009, Zhejiang, People's Republic of China.
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Xu CJ, Yu JT, Yang J, Yang S, Zhou ZK, Wen YB, Shang XP, Wen JG. [Influence of disposable diaper dependence on emotional behavior and related factors of preschool-aged children]. Zhonghua Yi Xue Za Zhi 2023; 103:3770-3775. [PMID: 38092554 DOI: 10.3760/cma.j.cn112137-20230310-00367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Objective: To investigate the influence of disposable diaper dependence (DDD) on emotional behavior and related factors of preschool-aged children. Methods: A total of 3 000 preschool-aged children from 16 kindergartens in Zhengzhou of Henan Province from October 2019 to March 2020 were selected and their parents were investigated by using a basic information questionnaire (including usage of disposable diapers), Strengths and Difficulties Questionnaire (SDQ) and Children's Sleep Questionnaire (PSQ). The differences in baseline and clinical data were compared between the DDD children and normal children, and multiple linear regression models were used to analyze the factors associated with emotional behavior in DDD children. Results: A total of 3 000 questionnaires were distributed and 2 775 (92.50%) were valid. The children ranged in age from 3 to 5 years, including 1 438 boys (51.82%) and 1 337 girls (48.18%). There were 98 (3.53%) children in DDD group and 2 677 (96.47%) children in normal group. The proportion of children living in cities in the DDD group was 58.16%, significantly higher than that of 41.84% in the normal children group (P<0.001). The abnormal detection rate of various factors in SDQ in DDD children, from high to low, were hyperactivity (n=14, 14.29%), peer communication problems (n=12, 12.24%), prosocial behavior (n=11, 11.22%), emotional symptoms (n=10, 10.20%) and conduct problems (n=7, 7.14%). The detection rates of abnormal total difficulty scores in DDD group and normal children were 7.14% (7 cases) and 0.78% (21 cases), respectively, with statistically significant differences (P<0.001). The proportions of emotional symptoms and hyperactivity disorder in DDD group were higher than those in normal group, and the differences were statistically significant (P<0.05). The PSQ score of children in DDD group was 3.01±2.02 which was not significantly different from the PSQ score of the normal group (2.71±2.10, P=0.157). The multi-factor analysis showed that caregiver's education level (β=-1.135,95%CI:-1.910 to -0.359), urinary incontinence (β=2.222, 95%CI: 1.105-3.339), fecal incontinence (β=3.833, 95%CI: 2.691-4.975), urinary and fecal incontinence (β=5.522, 95%CI: 4.145-6.899), and recurrent urinary tract infections(β=3.523,95%CI: 1.798-5.248)were the independent influencing factors of emotional behavioral problems in DDD children (P<0.05). Conclusions: Children with DDD are more likely to have emotional behavioral problems than normal children. Caregiver's education level, urinary incontinence and recurrent urinary tract infections were influencing factors of emotional behavioral problems in DDD children.
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Affiliation(s)
- C J Xu
- Department of Breast Surgery, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - J T Yu
- Department of Urology, the First Affiliated Hospital of Zhengzhou University, Henan Joint International Paediatric Urodynamic Laboratory, Zhengzhou 450052, China
| | - J Yang
- Department of Out-patient, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - S Yang
- Department of Urology, the First Affiliated Hospital of Zhengzhou University, Henan Joint International Paediatric Urodynamic Laboratory, Zhengzhou 450052, China
| | - Z K Zhou
- Department of Urology, the First Affiliated Hospital of Zhengzhou University, Henan Joint International Paediatric Urodynamic Laboratory, Zhengzhou 450052, China
| | - Y B Wen
- Department of Urology, the First Affiliated Hospital of Zhengzhou University, Henan Joint International Paediatric Urodynamic Laboratory, Zhengzhou 450052, China
| | - X P Shang
- Department of Medical Record Management, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - J G Wen
- Department of Urology, the First Affiliated Hospital of Zhengzhou University, Henan Joint International Paediatric Urodynamic Laboratory, Zhengzhou 450052, China
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Martínez Hernández A, Aliaga Hilario E, Coret Franco A, Laguna Sastre JM. Anal sphincter injury by bullfighting trauma. Tech Coloproctol 2023; 28:5. [PMID: 38071670 DOI: 10.1007/s10151-023-02893-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 11/17/2023] [Indexed: 12/18/2023]
Affiliation(s)
- Andreu Martínez Hernández
- Department of General and Visceral Surgery, General University Hospital, Castellón, Spain.
- Professor of General Surgery at Jaume I University, Castellón, Spain.
| | - Elena Aliaga Hilario
- Department of General and Visceral Surgery, General University Hospital, Castellón, Spain
| | - Alba Coret Franco
- Department of General and Visceral Surgery, General University Hospital, Castellón, Spain
- Professor of General Surgery at Jaume I University, Castellón, Spain
| | - José Manuel Laguna Sastre
- Department of General and Visceral Surgery, General University Hospital, Castellón, Spain
- Professor of General Surgery at Jaume I University, Castellón, Spain
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Cartaxo AL, Fernandes-Platzgummer A, Rodrigues CA, Melo AM, Tecklenburg K, Margreiter E, Day RM, da Silva CL, Cabral JM. Developing a Cell-Microcarrier Tissue-Engineered Product for Muscle Repair Using a Bioreactor System. Tissue Eng Part C Methods 2023; 29:583-595. [PMID: 37842845 PMCID: PMC10714258 DOI: 10.1089/ten.tec.2023.0122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Accepted: 09/01/2023] [Indexed: 10/17/2023] Open
Abstract
Fecal incontinence, although not life-threatening, has a high impact on the economy and patient quality of life. So far, available treatments are based on both surgical and nonsurgical approaches. These can range from changes in diet, to bowel training, or sacral nerve stimulation, but none of which provides a long-term solution. New regenerative medicine-based therapies are emerging, which aim at regenerating the sphincter muscle and restoring continence. Usually, these consist of the administration of a suspension of expanded skeletal-derived muscle cells (SkMDCs) to the damaged site. However, this strategy often results in a reduced cell viability due to the need for cell harvesting from the expansion platform, as well as the non-native use of a cell suspension to deliver the anchorage-dependent cells. In this study, we propose the proof-of-concept for the bioprocessing of a new cell delivery method for the treatment of fecal incontinence, obtained by a scalable two-step process. First, patient-isolated SkMDCs were expanded using planar static culture systems. Second, by using a single-use PBS-MINI Vertical-Wheel® bioreactor, the expanded SkMDCs were combined with biocompatible and biodegradable (i.e., directly implantable) poly(lactic-co-glycolic acid) microcarriers prepared by thermally induced phase separation. This process allowed for up to 80% efficiency of SkMDCs to attach to the microcarriers. Importantly, SkMDCs were viable during all the process and maintained their myogenic features (e.g., expression of the CD56 marker) after adhesion and culture on the microcarriers. When SkMDC-containing microcarriers were placed on a culture dish, cells were able to migrate from the microcarriers onto the culture surface and differentiate into multinucleated myotubes, which highlights their potential to regenerate the damaged sphincter muscle after administration into the patient. Overall, this study proposes an innovative method to attach SkMDCs to biodegradable microcarriers, which can provide a new treatment for fecal incontinence.
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Affiliation(s)
- Ana Luísa Cartaxo
- Department of Bioengineering and Institute for Bioengineering and Biosciences (iBB), Instituto Superior Técnico, Universidade de Lisboa, Lisboa, Portugal
- Associate Laboratory, Institute for Health and Bioeconomy (i4HB), Instituto Superior Técnico, Universidade de Lisboa, Lisboa, Portugal
| | - Ana Fernandes-Platzgummer
- Department of Bioengineering and Institute for Bioengineering and Biosciences (iBB), Instituto Superior Técnico, Universidade de Lisboa, Lisboa, Portugal
- Associate Laboratory, Institute for Health and Bioeconomy (i4HB), Instituto Superior Técnico, Universidade de Lisboa, Lisboa, Portugal
| | - Carlos A.V. Rodrigues
- Department of Bioengineering and Institute for Bioengineering and Biosciences (iBB), Instituto Superior Técnico, Universidade de Lisboa, Lisboa, Portugal
- Associate Laboratory, Institute for Health and Bioeconomy (i4HB), Instituto Superior Técnico, Universidade de Lisboa, Lisboa, Portugal
| | - Ana M. Melo
- Department of Bioengineering and Institute for Bioengineering and Biosciences (iBB), Instituto Superior Técnico, Universidade de Lisboa, Lisboa, Portugal
- Associate Laboratory, Institute for Health and Bioeconomy (i4HB), Instituto Superior Técnico, Universidade de Lisboa, Lisboa, Portugal
| | | | | | - Richard M. Day
- Centre for Precision Healthcare, Division of Medicine, University College London, London, United Kingdom
| | - Cláudia L. da Silva
- Department of Bioengineering and Institute for Bioengineering and Biosciences (iBB), Instituto Superior Técnico, Universidade de Lisboa, Lisboa, Portugal
- Associate Laboratory, Institute for Health and Bioeconomy (i4HB), Instituto Superior Técnico, Universidade de Lisboa, Lisboa, Portugal
| | - Joaquim M.S. Cabral
- Department of Bioengineering and Institute for Bioengineering and Biosciences (iBB), Instituto Superior Técnico, Universidade de Lisboa, Lisboa, Portugal
- Associate Laboratory, Institute for Health and Bioeconomy (i4HB), Instituto Superior Técnico, Universidade de Lisboa, Lisboa, Portugal
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13
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An Y, Chen X, Tian M, Qi W, Gao J. Comparison of clinical outcomes of anal fistula plug and endoanal advancement flap repair treating the complex anal fistula: a systematic review and meta-analysis. Updates Surg 2023; 75:2103-2115. [PMID: 37882975 PMCID: PMC10710391 DOI: 10.1007/s13304-023-01674-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 10/07/2023] [Indexed: 10/27/2023]
Abstract
Anal fistula (AF) is a common disease with high prevalence and surgical operations are effective treatments in clinical work. There exist many well-known surgical techniques treating complex anal fistula (CAF), however, none is ideal. To compare the superiority of Anal fistula plug (AFP) and Endoanal advancement flap repair (EAFR) for complex anal fistula. We searched worldwide databases including Pubmed, Embase, Cochrane Library, Web of Science, CNKI, WanFang, VIP, and SinoMed from their inception to March 2023. Studies comparing the outcomes of AFP and EAFR were included according to the PICO principles. The indicators of the healing rate, recurrence rate, wound infection rate, and complication rate, et al. were extracted and compared between different surgical methods. 5 RCTS and 7 non-RCTs were included in the meta-analysis with a total of 847 patients (341 patients conducted with AFP and 506 patients with EAFR). By combining the total effect of the 12 articles, we found that there was a statistical difference reporting the healing rate of AFP 48.3% and EAFR 64.4% treating the CAF (OR 0.68, 95% CI 0.30,1.55, P = 0.03), and EAFR has a better healing rate. However, there was no significant difference in terms of the recurrence rate (OR 1.68, 95% CI 0.80,3.54, P = 0.17), the wound infection rate (OR 1.82, 95% CI 0.95,3.52, P = 0.07), and the complication rate (OR 1.06, 95% CI 0.70,1.61, P = 0.77) either in the 12 articles or in the subgroup. The meta-analysis indicated that the EAFR was superior to AFP in terms of the healing rate treating the CAF, however, there were no significant differences between the two groups when it came to the recurrence rate, the wound infection rate, and the complication rate. EAFR might be one initial treatment for the complex cryptoglandular anal fistulas compared with AFP.
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Affiliation(s)
- Yongkang An
- The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, China
- Graduate School, Hebei University of Chinese Medicine, Shijiazhuang, China
| | - Xueqing Chen
- Anorectal Department, The First Affiliated Hospital of Hebei University of Chinese Medicine, 389, Zhongshan East Road, Shijiazhuang, 050000, Hebei Province, China
| | - Maosheng Tian
- Anorectal Department, The First Affiliated Hospital of Hebei University of Chinese Medicine, 389, Zhongshan East Road, Shijiazhuang, 050000, Hebei Province, China
| | - Wenyue Qi
- Staff Hospital of Hebei Normal University, Shijiazhuang, China
| | - Jihua Gao
- Anorectal Department, The First Affiliated Hospital of Hebei University of Chinese Medicine, 389, Zhongshan East Road, Shijiazhuang, 050000, Hebei Province, China.
- Key Laboratory of Integrated Chinese Medicine and Western Medicine for Gastroenterology Research (Hebei), Shijiazhuang, China.
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14
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Shen Y, Yang T, Zeng H, Meng W, Deng X, Wei M, Wang Z. Low anterior resection syndrome and quality of life after intersphincteric resection for rectal cancer: a propensity score-matched study. Tech Coloproctol 2023; 27:1307-1317. [PMID: 37804461 DOI: 10.1007/s10151-023-02848-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 07/26/2023] [Indexed: 10/09/2023]
Abstract
PURPOSE Our aim was to perform a propensity score-matched study to compare the long-term functional outcomes and quality of life following intersphincteric resection vs. low anterior resection (LAR) with very low anastomosis. METHODS Patients who underwent intersphincteric resection or low anterior resection with low anastomosis (≤ 4 cm from the anal verge) for rectal cancer between January 2017 and June 2020 were retrospectively included. A propensity score-matching process was performed. Functional outcomes and quality of life were assessed using the European Quality of Life 5 Dimensions 3 Level Version (EQ-5D-3L), EORC-QLQ C30, EORC-QLQ CR29, Low Anterior Resection Syndrome (LARS), Wexner, and International Prostate Symptom Score (IPSS) questionnaires. The primary outcome was the presence of LARS at least 12 months after surgery. The second outcome was the postoperative quality of life of included patients. RESULTS After propensity matching, 128 patients were included, including 58 males and 70 females with a median age of 59.5. Patients in the intersphincteric resection group showed a higher incidence of incontinence to flatus (32.8% versus 14.0%, p = 0.043) and stools (42.2% versus 21.9%, p = 0.046), pain/discomfort (25.0% versus 7.8%, p = 0.001), and bowel dysfunction, while the LARS scores (15.0 versus 13.2, p = 0.461) and major LARS rates (26.6% versus 14.1%, p = 0.078) were comparable in both groups. CONCLUSION ISR leads to increased bowel incontinence rate and increased anal pain, without affecting the grade of low anterior resection syndrome, fecal urgency, and clustering. LAR might be the preferred sphincteric-preserving approach when negative resection margins and a safe anastomosis are guaranteed. Patients should be fully informed about potential functional impairment after sphincter-preservation procedures.
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Affiliation(s)
- Y Shen
- Department of General Surgery, Colorectal Cancer Center, West China Hospital, Sichuan University, Guo Xue Xiang 37#, Chengdu, Sichuan Province, China
| | - T Yang
- Department of General Surgery, Colorectal Cancer Center, West China Hospital, Sichuan University, Guo Xue Xiang 37#, Chengdu, Sichuan Province, China
| | - H Zeng
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - W Meng
- Department of General Surgery, Colorectal Cancer Center, West China Hospital, Sichuan University, Guo Xue Xiang 37#, Chengdu, Sichuan Province, China
| | - X Deng
- Department of General Surgery, Colorectal Cancer Center, West China Hospital, Sichuan University, Guo Xue Xiang 37#, Chengdu, Sichuan Province, China.
| | - M Wei
- Department of General Surgery, Colorectal Cancer Center, West China Hospital, Sichuan University, Guo Xue Xiang 37#, Chengdu, Sichuan Province, China.
| | - Z Wang
- Department of General Surgery, Colorectal Cancer Center, West China Hospital, Sichuan University, Guo Xue Xiang 37#, Chengdu, Sichuan Province, China.
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15
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van der Ende-van Loon M, Korteling D, Willekens H, Schilders M, Curvers W, Bisschops R, Schoon E, Terwee C. Dutch-Flemish translation and validation of the gastrointestinal symptom scales from the patient‑reported outcomes measurement information system (PROMIS) ®. J Patient Rep Outcomes 2023; 7:125. [PMID: 38032401 PMCID: PMC10689627 DOI: 10.1186/s41687-023-00662-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 11/15/2023] [Indexed: 12/01/2023] Open
Abstract
PURPOSE To translate the eight PROMIS® GastrointestinaI Symptom Scales into Dutch-Flemish and to evaluate their psychometric properties. METHODS This study consisted of two parts: (1) translation according to the Functional Assessment of Chronic Illness Therapy (FACIT) translation methodology and (2) evaluation of psychometric properties: structural validity, using confirmatory factor analysis; and construct validity using hypothesis testing. RESULTS In the first part of the study, in 19 out of the 77 items (24.7%) translation was challenging. After discussion between the translators, consensus could be achieved. In the cognitive debriefing interview phase, ten minor changes in the wording of items were made. A universal Dutch-Flemish translation for all 77 items was obtained. In de second part of the study a good fit was found for three DF-PROMIS GI Scales: Bowel Incontinence, Gas and Bloating, and Belly Pain. Four scales (Reflux, Disrupted Swallowing, Diarrhea, and Constipation) did not show sufficient fit and fit for the Nausea and Vomiting scale could not be assessed because of skewed responses. Construct validity was considered sufficient for six out of eight DF-PROMIS GI Scales. Less than 75% of hypothesis for de Constipation and Disrupted Swallowing scales could be confirmed. CONCLUSION The PROMIS GI Symptom Scales were successfully translated into DutchFlemish. The findings suggest a sufficient structural validity for the PROMIS GI Scales. Bowel Incontinence, Gas and Bloating and Belly Pain. Construct validity was sufficient for the Scales Gas and Bloating, Incontinence, Nausea and Vomiting, Reflux, Belly Pain, and Diarrhea.
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Affiliation(s)
- Mirjam van der Ende-van Loon
- Department of Gastroenterology and Hepatology, Catharina Hospital, Michelangelolaan 2, 5623 EJ, Eindhoven, The Netherlands.
- GROW: School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands.
| | - Dorinde Korteling
- Child and Adolescent Psychiatry and Psychosocial Care, Amsterdam UMC Location, Emma Children's Hospital, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development, Child Development, Amsterdam, The Netherlands
- Amsterdam Public Health, Mental Health and Methodology, Amsterdam, The Netherlands
| | - Hilde Willekens
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
| | - Monique Schilders
- Department of Gastroenterology and Hepatology, Catharina Hospital, Michelangelolaan 2, 5623 EJ, Eindhoven, The Netherlands
| | - Wouter Curvers
- Department of Gastroenterology and Hepatology, Catharina Hospital, Michelangelolaan 2, 5623 EJ, Eindhoven, The Netherlands
| | - Raf Bisschops
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
| | - Erik Schoon
- Department of Gastroenterology and Hepatology, Catharina Hospital, Michelangelolaan 2, 5623 EJ, Eindhoven, The Netherlands
- GROW: School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
| | - Caroline Terwee
- Department of Epidemiology and Data Science, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Methodology, Amsterdam, The Netherlands
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16
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Cooper EA, Cunningham C, Lindsey I. Role of Sacral Nerve Stimulation in Rectoanal Intussusception. Dis Colon Rectum 2023; 66:e1138. [PMID: 37535145 DOI: 10.1097/dcr.0000000000003023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/04/2023]
Affiliation(s)
- Edward A Cooper
- Department of Colorectal Surgery, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
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17
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Gray M. Context for Practice: Cancer-Related Wounds, Cost of Living With a New Fecal Ostomy, Intermittent Catheterization Education, and Innovation in Catheter Design. J Wound Ostomy Continence Nurs 2023; 50:443-444. [PMID: 37966068 DOI: 10.1097/won.0000000000001033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2023]
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18
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Worrall AP, O'Leary BD, Salameh F. Obstetric anal sphincter injury (OASI) in the presence of an intact perineum. BMJ Case Rep 2023; 16:e253922. [PMID: 37848273 PMCID: PMC10583107 DOI: 10.1136/bcr-2022-253922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/03/2023] [Indexed: 10/19/2023] Open
Abstract
Obstetric anal sphincter injury (OASI) in the absence of concurrent injury to the perineal skin is not a common diagnosis. A primiparous woman delivered a healthy male infant by spontaneous vertex delivery. At time of delivery, a compound presentation of the fetal hand with the head was noted. Initial examination revealed a presumed second-degree tear; however, a small laceration above the anal verge was noted, which on exploration revealed a perineal injury through the anal sphincter complex. In the operating theatre, the perineal skin was incised to reveal a 3c OASI, which was repaired appropriately. While atypical OASI has been reported previously, this specific injury has never been described in detail in the literature. Awareness of atypical perineal injuries is needed and while careful perineal examination is required in all cases, this is especially important where the perineal skin appears intact to ensure appropriate diagnosis of any concurrent OASI.
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Affiliation(s)
- Amy P Worrall
- Obstetrics and Gynaecology, Rotunda Hospital, Dublin 1, Ireland
| | - Bobby D O'Leary
- Obstetrics and Gynaecology, Rotunda Hospital, Dublin 1, Ireland
| | - Fadi Salameh
- Obstetrics and Gynaecology, Rotunda Hospital, Dublin 1, Ireland
- Department of Obstetrics and Gynaecology, Royal College of Surgeons in Ireland, Dublin 2, Ireland
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19
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Yiasemidou M, Yates C, Cooper E, Goldacre R, Lindsey I. External rectal prolapse: more than meets the eye. Tech Coloproctol 2023; 27:783-785. [PMID: 37278904 DOI: 10.1007/s10151-023-02829-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 05/29/2023] [Indexed: 06/07/2023]
Affiliation(s)
- M Yiasemidou
- Pelvic Floor Unit, Department of Colorectal Surgery, Oxford University Hospitals NHS Trust, Oxford, England
| | - C Yates
- Pelvic Floor Unit, Department of Colorectal Surgery, Oxford University Hospitals NHS Trust, Oxford, England
| | - E Cooper
- Pelvic Floor Unit, Department of Colorectal Surgery, Oxford University Hospitals NHS Trust, Oxford, England
| | - R Goldacre
- Nuffield Department of Population Health, Big Data Institute, Oxford University, Oxford, England
| | - I Lindsey
- Pelvic Floor Unit, Department of Colorectal Surgery, Oxford University Hospitals NHS Trust, Oxford, England.
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20
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Luchristt D, Kawasaki A. Successful sacral neuromodulation treatment of refractory faecal incontinence in a patient with spina bifida and partial sacral agenesis. BMJ Case Rep 2023; 16:e254835. [PMID: 37669822 PMCID: PMC10481722 DOI: 10.1136/bcr-2023-254835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/07/2023] Open
Abstract
A woman in her early 20s with a history of lumbosacral lipomyelomeningocele with associated partial sacral agenesis and tethered cord was referred for possible sacral neuromodulation treatment of her refractory faecal incontinence. Anorectal testing revealed a thinned and weakened anal sphincter complex with absent left-sided bulbocavernosus and anal wink reflexes.Through a two-stage approach, she underwent successful placement of a chronic tined quadripolar sacral nerve lead and implanted pulse generator. Despite significant distortion of normal bony anatomic landmarks, bilateral S3 and S4 foraminal entry was possible, with intraoperative motor and sensory testing providing key confirmation of appropriate lead placement. The patient had a substantial improvement in her baseline frequency and urgency with a near-complete resolution of faecal incontinence episodes during her test phase.
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Affiliation(s)
- Douglas Luchristt
- Obstetrics and Gynecology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Amie Kawasaki
- Obstetrics and Gynecology, Duke University School of Medicine, Durham, North Carolina, USA
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21
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Machado NC, Carvalho MDA. The Groningen Defecation and Fecal Continence Questionnaire: the long way of an organized and methodical translation of Dutch to English, English to Chinese, and back to English and Dutch versions. Ann Palliat Med 2023; 12:881-883. [PMID: 37355807 DOI: 10.21037/apm-23-361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 06/07/2023] [Indexed: 06/26/2023]
Affiliation(s)
- Nilton Carlos Machado
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Botucatu Medical School, São Paulo State University, Botucatu, Sao Paulo, Brazil
| | - Mary de Assis Carvalho
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Botucatu Medical School, São Paulo State University, Botucatu, Sao Paulo, Brazil
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22
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Sun G, Trzpis M, Ding H, Gao X, Broens PMA, Zhang W. Co-occurrence of fecal incontinence with constipation or irritable bowel syndrome indicates the need for personalized treatment. Neurogastroenterol Motil 2023; 35:e14633. [PMID: 37427541 DOI: 10.1111/nmo.14633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 05/23/2023] [Accepted: 05/31/2023] [Indexed: 07/11/2023]
Abstract
BACKGROUND This study aimed to compare the prevalence and symptoms of fecal incontinence (FI) in relation to irritable bowel syndrome (IBS-associated FI), constipation (constipation-associated FI), and isolation (isolated FI). METHODS Data were analyzed from 3145 respondents without organic comorbidities known to influence defecation function from the general Chinese population who filled in the online Groningen Defecation and Fecal Continence questionnaire. FI, IBS, and constipation were evaluated with the Rome IV criteria. KEY RESULTS The prevalence of FI was 10.5% (n = 329) in the non-comorbidity group. After multivariable logistic regression analysis, IBS (odds ratio [OR]: 12.55, 95% confidence interval [CI]: 9.06-17.36) and constipation (OR: 4.38, 95% CI: 3.27-5.85) were the most significant factors contributing to FI. Based on this finding, 106/329 (32.2%) had IBS-associated FI, 119/329 (36.2%) had constipation-associated FI, and 104/329 (31.6%) had isolated FI. Among the 329 FI respondents, there was a high prevalence of IBS and constipation-related symptoms, including abdominal pain (81.5%) and abdominal bloating (77.8%) for IBS and straining during defecation (75.4%), incomplete defecation (72.3%), defecation blockage (63.2%), anal pain during defecation (59.3%), and hard stools (24%) for constipation. The patients with IBS-associated FI asked for specialists' help less frequently than those with isolated FI. Interestingly, among the patients with constipation-associated FI, 56.3% used anti-diarrhea medicine. CONCLUSIONS AND INFERENCES The prevalence of IBS-associated FI, constipation-associated FI, and isolated FI is comparably high. It is important to diagnose and target the cause of FI to provide personalized and cause-targeting care instead of treating only the FI symptoms.
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Affiliation(s)
- Ge Sun
- Department of Surgery, Anorectal Physiology Laboratory, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Department of Colorectal Surgery, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Monika Trzpis
- Department of Surgery, Anorectal Physiology Laboratory, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Haibo Ding
- Department of Colorectal Surgery, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Xianhua Gao
- Department of Colorectal Surgery, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Paul M A Broens
- Department of Surgery, Anorectal Physiology Laboratory, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Department of Surgery, Division of Pediatric Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Wei Zhang
- Department of Colorectal Surgery, Changhai Hospital, Naval Medical University, Shanghai, China
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23
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Bukovec P, Šturm Indihar B, Hodnik JJ, Drusany Starič K. The knowledge gap in influence of fundal pressure during delivery on obstetric anal sphincter injury. Eur J Obstet Gynecol Reprod Biol 2023; 288:231. [PMID: 37524646 DOI: 10.1016/j.ejogrb.2023.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 07/17/2023] [Indexed: 08/02/2023]
Affiliation(s)
- Petra Bukovec
- Division of Gynaecology and Obstetrics, Department of Gynaecology, Department of Obstetircs and Gynecology, University Medical Centre Ljubljana, Medical Faculty, University of Ljubljana, 1000 Ljubljana, Slovenia
| | - Blažka Šturm Indihar
- Division of Gynaecology and Obstetrics, Department of Gynaecology, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia
| | - Jaka Jakob Hodnik
- Scottish Centre for Production Animal Health & Food Safety, School of Biodiversity, One Health & Veterinary Medicine, University of Glasgow, Scotland, United Kingdom
| | - Kristina Drusany Starič
- Division of Gynaecology and Obstetrics, Department of Gynaecology, University Medical Centre Ljubljana, Medical Faculty, University of Ljubljana, 1000 Ljubljana, Slovenia.
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24
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Wang M, Liu Y, Liao Y, Yu H. Research on biomechanical compatibility for a novel artificial anal sphincter with constant force. Artif Organs 2023; 47:1285-1297. [PMID: 36869693 DOI: 10.1111/aor.14517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Revised: 02/10/2023] [Accepted: 02/28/2023] [Indexed: 03/05/2023]
Abstract
BACKGROUND Existing artificial anal sphincter studies have shown that biomechanical compatibility problem between artificial anal sphincter and rectum caused by long-term morphological changes of the tissue surrounding the implanted prosthesis can lead to device failure or tissue ischemic necrosis. In this article, a mechanical artificial anal sphincter with constant force clamping is designed based on the superelasticity of shape memory alloys, which improved the biomechanical compatibility of implantable artificial anal sphincter. METHODS Firstly, the anatomical structure and the biomechanical properties of the rectum are analyzed to obtain the size parameters and material parameters of the rectal model. Secondly, a novel artificial anal sphincter with constant force is designed to improve the biomechanical compatibility between the artificial sphincter and the rectum. Thirdly, the static analysis of artificial anal sphincter is carried out by finite element analysis. RESULTS The simulation results show that the artificial anal sphincter can maintain a constant clamping force of 4 N within a certain variation range of intestinal tissue thickness, which verifies the constant force characteristic of the artificial anal sphincter. The constant clamping force of the artificial anal sphincter to the rectum is 4 N that is greater than the clamping force 3.99 N required to close the rectum, which verifies the effectiveness the artificial anal sphincter. The surface contact stress and the minimum principal stress of the rectum in the clamping state are less than the pressure threshold, which verifies the safety of the artificial anal sphincter. CONCLUSIONS The novel artificial anal sphincter has better biomechanical compatibility and improves the mechanical match between artificial sphincter and intestinal tissue. This study may provide more reasonable and effective simulation data for in vivo experiments of artificial anal sphincter in future, which may provide theoretical and technical support for further research about clinical application of artificial anal sphincter.
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Affiliation(s)
- Minghui Wang
- Institute of Rehabilitation Engineering and Technology, School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, China
- Shanghai Engineering Research Center of Assistive Devices, Shanghai, China
| | - Yunlong Liu
- Institute of Rehabilitation Engineering and Technology, School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, China
- Shanghai Engineering Research Center of Assistive Devices, Shanghai, China
| | - Yucheng Liao
- Institute of Rehabilitation Engineering and Technology, School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, China
- Shanghai Engineering Research Center of Assistive Devices, Shanghai, China
| | - Hongliu Yu
- Institute of Rehabilitation Engineering and Technology, School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, China
- Shanghai Engineering Research Center of Assistive Devices, Shanghai, China
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25
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Aho Fält U, Zawadzki A, Starck M, Bohe M, Regnér S, Johnson LB. Postoperative three-dimensional endoanal ultrasound findings and relation to anal fistula plug failure. Scand J Gastroenterol 2023; 58:1200-1206. [PMID: 37203207 DOI: 10.1080/00365521.2023.2212310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 05/05/2023] [Indexed: 05/20/2023]
Abstract
OBJECTIVES To explore the utilization of three-dimensional (3D) endoanal ultrasound (EAUS) for the follow-up of the anal fistula plug (AFP), describe morphological findings in postoperative 3D EAUS, and evaluate if postoperative 3D EAUS combined with clinical symptoms can predict AFP failure. MATERIALS AND METHODS A retrospective analysis of 3D EAUS examinations performed during a single-centre study of prospectively included consecutive patients treated with the AFP between May 2006 and October 2009. Postoperative assessment by clinical examination and 3D EAUS was performed at 2 weeks, 3 months and 6-12 months ("late control"). Long-term follow-up was carried out in 2017. The 3D EAUS examinations were blinded and analysed by two observers using a protocol with defined relevant findings for different follow-up time points. RESULTS A total of 95 patients with a total of 151 AFP procedures were included. Long-term follow-up was completed in 90 (95%) patients. Inflammation at 3 months, gas in fistula and visible fistula at 3 months and at late control, were statistically significant 3D EAUS findings for AFP failure. The combination of gas in fistula and clinical finding of fluid discharge through the external fistula opening 3 months postoperatively was statistically significant (p < 0.001) for AFP failure with 91% sensitivity and 79% specificity. The positive predictive value was 91%, while the negative predictive value was 79%. CONCLUSIONS 3D EAUS may be utilized for the follow-up of AFP treatment. Postoperative 3D EAUS at 3 months or later, especially if combined with clinical symptoms, can be used to predict long-term AFP failure.ClinicalTrials.gov identifier NCT03961984.
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Affiliation(s)
- Ursula Aho Fält
- Department of Surgery, Skåne University Hospital - Malmö, Lund University, Sweden
| | - Antoni Zawadzki
- Department of Surgery, Skåne University Hospital - Malmö, Lund University, Sweden
| | - Marianne Starck
- Department of Surgery, Skåne University Hospital - Malmö, Lund University, Sweden
| | - Måns Bohe
- Department of Surgery, Skåne University Hospital - Malmö, Lund University, Sweden
| | - Sara Regnér
- Department of Surgery, Skåne University Hospital - Malmö, Lund University, Sweden
| | - Louis B Johnson
- Department of Surgery, Skåne University Hospital - Malmö, Lund University, Sweden
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Zhang B, Ding JH. [Advances in functional assessment and bowel rehabilitation following intersphincteric resection for low rectal cancer]. Zhonghua Wei Chang Wai Ke Za Zhi 2023; 26:607-613. [PMID: 37583016 DOI: 10.3760/cma.j.cn441530-20230310-00076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 08/17/2023]
Abstract
Intersphincteric resection (ISR) has been performed as an ultimate sphincter-sparing strategy in selected patients with low rectal cancer. Accumulating evidence suggests that ISR may be an interesting alternative to abdominoperineal resection to avoid a permanent stoma without compromising oncological outcomes. However, bowel dysfunction is a most common consequence of ISR not to be neglected. To date, limited clinical research has reported functional and quality of life outcomes according to patient-reported outcome measures. Also, data concerning management of low anterior resection syndrome are scarce due to lack of quality evidence. Therefore, this review provides an up-to-date summary of systematic assessment (including function, quality of life, manometry and morphology) and bowel rehabilitation for ISR patients. Postoperative anal function is often assessed by a combination of scales, including the Incontinence Assessment Scale, the Gastrointestinal Function Questionnaire, the Specific LARS Assessment Scale and the Faecal Diary. The condition-specific Quality of Life Scale is more appropriate for Quality-of-life measures in fecal incontinence after ISR. Patients' physiological function after ISR can be assessed using water- or high-resolution solid-state anorectal manometry. Anatomical and morphological changes can be assessed using defecography and 3D endorectal ultrasound. Electrical stimulation and biofeedback, pelvic floor exercises, rectal balloon training, transanal irrigation and sacral neuromodulation are all options for post-operative rehabilitation.
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Affiliation(s)
- B Zhang
- Department of Colorectal Surgery, the Characteristic Medical Center of PLA Rocket Force, Beijing 100088, China
| | - J H Ding
- Department of Colorectal Surgery, the Characteristic Medical Center of PLA Rocket Force, Beijing 100088, China
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Alshiek J, Murad-Regadas SM, Mellgren A, Glanc P, Khatri G, Quiroz LH, Weinstein MM, Rostaminia G, Oliveira L, Arif-Tiwari H, Ferrari L, Bordeianou L, Shobeiri SA. Consensus definitions and interpretation templates for dynamic ultrasound imaging of defecatory pelvic floor disorders : Proceedings of the consensus meeting of the pelvic floor disorders consortium of the american society of colon and rectal surgeons, the society of abdominal radiology, the international continence society, the American urogynecologic society, the international urogynecological association, and the society of gynecologic surgeons. Int Urogynecol J 2023; 34:603-619. [PMID: 36617601 DOI: 10.1007/s00192-022-05414-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/10/2022] [Indexed: 01/09/2023]
Affiliation(s)
- Jonia Alshiek
- Department of Obstetrics and Gynecology, Inova Health System, Fairfax, VA, USA
- Urogynecology Unit, Technion Medical School, Hillel Yaffe Medical Center, Hadera, Israel
| | - Sthela M Murad-Regadas
- Department of Surgery, School of Medicine of the Federal University of Ceará, Fortaleza, Brazil
| | - Anders Mellgren
- Department of Surgery, University of Illinois, Chicago, IL, USA
| | - Phyllis Glanc
- Department of Medical Imaging, Sunnybrook Health Sciences Center, University of Toronto, Toronto, ON, Canada
| | - Gaurav Khatri
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Lieschen H Quiroz
- Department of Obstetrics and Gynecology, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Milena M Weinstein
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, Pelvic Floor Disorders Center, Harvard Medical School, Boston, MA, USA
| | - Ghazaleh Rostaminia
- Department of Obstetrics and Gynecology, Northshore Hospital, Chicago, IL, USA
| | - Lucia Oliveira
- Department of Colorectal Surgery Hospital Casa de Saúde São José, Rio de Janeiro, Brazil
| | - Hina Arif-Tiwari
- Department of Medical Imaging, College of Medicine, University of Arizona, Tucson, AZ, USA
| | | | - Liliana Bordeianou
- Department of Surgery, Massachusetts General Hospital, Pelvic Floor Disorders Center, Harvard Medical School, 55 Fruit St, GRB 425, Boston, MA, 02114, USA.
| | - S Abbas Shobeiri
- Department of Obstetrics and Gynecology, Inova Health System, Fairfax, VA, USA
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Barch DH, Seibert JH, Kandilov A, Bernacet A, Deutsch A, Wang XJ, Scherer E, McMullen T, Mandl S, Levitt A, Frank J, Stephanopoulos C, Smith LM. Cross-setting Comparison of Risk Factors for Pressure Injuries Acquired in Post-Acute Care. Adv Skin Wound Care 2023; 36:128-136. [PMID: 36812077 DOI: 10.1097/01.asw.0000912008.97430.b4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
GENERAL PURPOSE To provide information on the association between risk factors and the development of new or worsened stage 2 to 4 pressure injuries (PIs) in patients in long-term care hospitals (LTCHs), inpatient rehabilitation facilities (IRFs), and skilled nursing facilities (SNFs). TARGET AUDIENCE This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care. LEARNING OBJECTIVES/OUTCOMES After participating in this educational activity, the participant will:1. Compare the unadjusted PI incidence in SNF, IRF, and LTCH populations.2. Explain the extent to which the clinical risk factors of functional limitation (bed mobility), bowel incontinence, diabetes/peripheral vascular disease/peripheral arterial disease, and low body mass index are associated with new or worsened stage 2 to 4 PIs across the SNF, IRF, and LTCH populations.3. Compare the incidence of new or worsened stage 2 to 4 PI development in SNF, IRF, and LTCH populations associated with high body mass index, urinary incontinence, dual urinary and bowel incontinence, and advanced age.
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Lindsay C, Wolfe L, Ductan C, LeBlanc K. The Influence of Absorbent Products on Skin Integrity: A Scoping Review. J Wound Ostomy Continence Nurs 2023; 50:151-160. [PMID: 36867039 DOI: 10.1097/won.0000000000000957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
PURPOSE Absorbent products are commonly used to absorb urine and fecal matter and to mitigate potential skin complications such as incontinence-associated dermatitis (IAD). Evidence concerning the effect these products have on skin integrity is limited. This scoping review aimed to explore the evidence/literature on the effect of absorbent containment products on skin integrity. METHOD A scoping literature review. SEARCH STRATEGY The electronic databases CINAHL, Embase, MEDLINE, and Scopus were searched for published articles between 2014 and 2019. Inclusion criteria were studies that focused on urinary and/or fecal incontinence, use of incontinent absorbent containment products, impact on skin integrity, and published in English. The search identified a total of 441 articles that were identified for the title and abstract review. FINDINGS Twelve studies met inclusion criteria and were included in the review. Variability in the study designs did not allow firm conclusions regarding which absorbent products contributed to or prevented IAD. Specifically, we found variations in assessment of IAD, study settings, and types of products used. IMPLICATIONS There is insufficient evidence to support the effectiveness of one product category over another for maintaining skin integrity in persons with urinary or fecal incontinence. This paucity of evidence illustrates the need for standardized terminology, a widely used instrument for assessment of IAD, and identification of a standard absorbent product. Additional research using both in vitro and in vivo models, along with real-world clinical studies, is needed to enhance current knowledge and evidence of the impact of absorbent products on skin integrity.
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Affiliation(s)
- Carly Lindsay
- Carly Lindsay, RN, BNSc, MClSc-WH, NSWOC, WOCC(C), Kingston Health Sciences Centre, Kingston General Hospital, Kingston, Ontario, Canada
- Lauren Wolfe, RN, BSN, MClSc-WH, NSWOC, CWOCN, Vancouver Coastal Health, Vancouver General Hospital, Vancouver, British Columbia, Canada
- Charline Ductan, RN, BScN, MClSc-WH, CGN(C), Sunnybrook St. Michael's Hospital - Unity Health, Toronto, Ontario, Canada
- Kimberly LeBlanc, PhD, RN, NSWOC, WOCC (C), FCAN, Academic Chair, Wound, Ostomy and Continence Institute; Association of Nurses Specialized in Wound, Ostomy and Continence Canada; Advanced Practice Nurse, KDS Professional Consulting; Adjunct Professor, Faculty of Health Sciences, Western University; Affiliate Faculty, Ingram School of Nursing; Faculty of Medicine, McGill University, Orléans, Ontario, Canada and Honorary Senior Lecturer, School of Medicine, Cardiff University, Wales, United Kingdom
| | - Lauren Wolfe
- Carly Lindsay, RN, BNSc, MClSc-WH, NSWOC, WOCC(C), Kingston Health Sciences Centre, Kingston General Hospital, Kingston, Ontario, Canada
- Lauren Wolfe, RN, BSN, MClSc-WH, NSWOC, CWOCN, Vancouver Coastal Health, Vancouver General Hospital, Vancouver, British Columbia, Canada
- Charline Ductan, RN, BScN, MClSc-WH, CGN(C), Sunnybrook St. Michael's Hospital - Unity Health, Toronto, Ontario, Canada
- Kimberly LeBlanc, PhD, RN, NSWOC, WOCC (C), FCAN, Academic Chair, Wound, Ostomy and Continence Institute; Association of Nurses Specialized in Wound, Ostomy and Continence Canada; Advanced Practice Nurse, KDS Professional Consulting; Adjunct Professor, Faculty of Health Sciences, Western University; Affiliate Faculty, Ingram School of Nursing; Faculty of Medicine, McGill University, Orléans, Ontario, Canada and Honorary Senior Lecturer, School of Medicine, Cardiff University, Wales, United Kingdom
| | - Charline Ductan
- Carly Lindsay, RN, BNSc, MClSc-WH, NSWOC, WOCC(C), Kingston Health Sciences Centre, Kingston General Hospital, Kingston, Ontario, Canada
- Lauren Wolfe, RN, BSN, MClSc-WH, NSWOC, CWOCN, Vancouver Coastal Health, Vancouver General Hospital, Vancouver, British Columbia, Canada
- Charline Ductan, RN, BScN, MClSc-WH, CGN(C), Sunnybrook St. Michael's Hospital - Unity Health, Toronto, Ontario, Canada
- Kimberly LeBlanc, PhD, RN, NSWOC, WOCC (C), FCAN, Academic Chair, Wound, Ostomy and Continence Institute; Association of Nurses Specialized in Wound, Ostomy and Continence Canada; Advanced Practice Nurse, KDS Professional Consulting; Adjunct Professor, Faculty of Health Sciences, Western University; Affiliate Faculty, Ingram School of Nursing; Faculty of Medicine, McGill University, Orléans, Ontario, Canada and Honorary Senior Lecturer, School of Medicine, Cardiff University, Wales, United Kingdom
| | - Kimberly LeBlanc
- Carly Lindsay, RN, BNSc, MClSc-WH, NSWOC, WOCC(C), Kingston Health Sciences Centre, Kingston General Hospital, Kingston, Ontario, Canada
- Lauren Wolfe, RN, BSN, MClSc-WH, NSWOC, CWOCN, Vancouver Coastal Health, Vancouver General Hospital, Vancouver, British Columbia, Canada
- Charline Ductan, RN, BScN, MClSc-WH, CGN(C), Sunnybrook St. Michael's Hospital - Unity Health, Toronto, Ontario, Canada
- Kimberly LeBlanc, PhD, RN, NSWOC, WOCC (C), FCAN, Academic Chair, Wound, Ostomy and Continence Institute; Association of Nurses Specialized in Wound, Ostomy and Continence Canada; Advanced Practice Nurse, KDS Professional Consulting; Adjunct Professor, Faculty of Health Sciences, Western University; Affiliate Faculty, Ingram School of Nursing; Faculty of Medicine, McGill University, Orléans, Ontario, Canada and Honorary Senior Lecturer, School of Medicine, Cardiff University, Wales, United Kingdom
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Kciuk O, Li Q, Huszti E, McDermott CD. Pelvic floor symptoms in cisgender women with Ehlers-Danlos syndrome: an international survey study. Int Urogynecol J 2023; 34:473-483. [PMID: 35751670 DOI: 10.1007/s00192-022-05273-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 05/30/2022] [Indexed: 01/26/2023]
Abstract
INTRODUCTION AND HYPOTHESIS Ehlers-Danlos Syndrome (EDS) is a group of inherited connective tissue disorders associated with abnormal collagen, and is more prevalent in women than in men. The aim of this cross-sectional study was to characterize pelvic floor symptoms in cisgender women with EDS and to describe their impact on quality of life. METHODS An online questionnaire on obstetric and gynecological experiences of cisgender women with EDS was disseminated through EDS patient societies and social media. This study was a sub-analysis of the broader questionnaire and focused on pelvic floor disorders, whereby self-reported symptoms and validated questionnaires were used to assess pelvic floor symptom severity (Pelvic Floor Distress Inventory, PFDI-20), impact on quality of life (Pelvic Floor Impact Questionnaire, PFIQ-7), and sexual function (Female Sexual Function Index, FSFI-6). Groups based on age and EDS type were compared using Kruskal-Wallis and Chi-squared tests. RESULTS A total of 1,303 participants were included in the analysis. Pelvic floor symptom prevalence included: stress urinary incontinence in 60%, urgency urinary incontinence in 54%, fecal incontinence in 24%, and pelvic organ prolapse in 21%. Bladder symptoms were reported to be the most bothersome. The impact of prolapse symptoms on quality of life was higher in women under age 40 than in older participants (p<0.001). Pelvic pain was reported in 71%. Pain ratings were highest for dysmenorrhea, muscle and joint pain, and backache (median 7 out of 10 for each). Almost half of participants screened positive for possible sexual dysfunction and 36% reported dyspareunia more than half the time. CONCLUSIONS This large, observational study demonstrated that cisgender women with EDS report a high prevalence of pelvic floor symptoms that appear to be more severe than in the general population.
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Affiliation(s)
- Olga Kciuk
- Department of Obstetrics and Gynaecology, University of Toronto, Toronto, ON, Canada
| | - Qixuan Li
- Biostatistics Research Unit, University Health Network, Toronto, ON, Canada
| | - Ella Huszti
- Biostatistics Research Unit, University Health Network, Toronto, ON, Canada
| | - Colleen D McDermott
- Division of Female Pelvic Medicine and Reconstructive Pelvic Surgery, Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada.
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Kelly MS, Sherburne E, Kerr J, Payne C, Dorries H, Beierwaltes P, Guerro A, Thibadeau J. Release and highlights of the Lifespan Bowel Management Protocol produced for clinicians who manage neurogenic bowel dysfunction in individuals with spina bifida. J Pediatr Rehabil Med 2023; 16:675-677. [PMID: 38160374 PMCID: PMC10789357 DOI: 10.3233/prm-230060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 11/20/2023] [Indexed: 01/03/2024] Open
Affiliation(s)
- Maryellen S. Kelly
- Department of Urology, Duke University, Durham, NC, USA
- Healthcare of Women and Children’s Division, School of Nursing, Duke University, Durham, NC, USA
| | - Eileen Sherburne
- Department of Nursing Research, Children’s Wisconsin, Milwaukee, WI, USA
| | - Joy Kerr
- Division of Urology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | | | | | - Patricia Beierwaltes
- College of Allied Health and Nursing, Minnesota State University, Mankato, Mankato, MN, USA
| | - Adam Guerro
- Spina Bifida Association, Arlington, VA, USA
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Okeahialam NA, Thakar R, Sultan AH. Comparison of diagnostic criteria for significant anal sphincter defects between endoanal and transperineal ultrasound. Ultrasound Obstet Gynecol 2022; 60:793-799. [PMID: 35638253 PMCID: PMC10100122 DOI: 10.1002/uog.24957] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 05/18/2022] [Accepted: 05/23/2022] [Indexed: 05/31/2023]
Abstract
OBJECTIVE To evaluate the agreement between three-dimensional endoanal ultrasound (EAUS) and four-dimensional transperineal ultrasound (TPUS) in measuring anal sphincter defect angle. METHODS This was a secondary analysis of the PERINEAL study, which evaluated the effect of perineal wound infection on anal sphincter integrity. Women were reviewed once a week, until their perineal wound had healed or for up to a maximum of 16 weeks. At each visit, both EAUS and TPUS (the latter at rest and on maximum pelvic floor muscle contraction (PFMC)) were performed to evaluate the presence of external (EAS) and internal (IAS) anal sphincter defect and measure the defect size. The largest angle size of a defect at the same sphincter level was analyzed. A defect was deemed significant if it was > 30°. Kappa coefficient (κ), intraclass correlation coefficient and standard error of measurement (SEM) were calculated, using EAUS as the reference standard. RESULTS In 73 women scanned at weekly intervals, a total of 250 EAUS and 250 TPUS scans were performed. An EAS defect was found in 55 (22.0%) EAUS images and 47 (18.8%) TPUS images. An IAS defect was found in 26 (10.4%) images on both modalities. There was excellent agreement (κ = 0.87) between TPUS and EAUS in diagnosing the presence of an EAS defect and perfect agreement (κ = 1.00) in diagnosing the presence of an IAS defect. TPUS performed at rest had poor and moderate agreement with EAUS in measuring EAS and IAS defect size, respectively, with respective SEMs of ± 16.1° and ± 27.9°. TPUS performed during maximum PFMC had poor and moderate agreement with EAUS in measuring EAS and IAS defect size, respectively, with respective SEMs of ± 16.5° and ± 26.4°. Based on the SEMs, if the diagnostic cut-off of 30° for defect size on TPUS was used, an incorrect diagnosis of significant EAS defect could occur in approximately 9-36% of women and an incorrect diagnosis of a significant IAS defect could occur in approximately 4-15% of women, using EAUS as the reference. CONCLUSIONS This is the first study to compare directly anal sphincter defect angle measurements obtained on EAUS and TPUS. A cut-off angle of 30° should not be used for the diagnosis of a significant residual anal sphincter defect during TPUS examination. Further research is required to determine the optimal defect cut-off angle for TPUS. © 2022 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- N. A. Okeahialam
- Urogynaecology and Pelvic Floor Reconstruction UnitCroydon University HospitalCroydonUK
| | - R. Thakar
- Urogynaecology and Pelvic Floor Reconstruction UnitCroydon University HospitalCroydonUK
- St George's University of LondonLondonUK
| | - A. H. Sultan
- Urogynaecology and Pelvic Floor Reconstruction UnitCroydon University HospitalCroydonUK
- St George's University of LondonLondonUK
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Kurt S, Caron B, Gouynou C, Netter P, Vaizey CJ, Wexner SD, Danese S, Baumann C, Peyrin-Biroulet L. Faecal incontinence in inflammatory bowel disease: The Nancy experience. Dig Liver Dis 2022; 54:1195-1201. [PMID: 35123908 DOI: 10.1016/j.dld.2022.01.125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Revised: 01/10/2022] [Accepted: 01/14/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Faecal incontinence (FI) is a disabling condition in patients with inflammatory bowel disease (IBD). The diagnosis of FI is not easy as patients are reluctant to report this embarrassing symptom. The objectives of this study were to characterize the prevalence of FI in IBD patients using available scoring systems, and to identify associated risk factors. METHODS A FI clinic was implemented in routine practice between January 2020 and April 2021. FI was defined as a Wexner score ≥5. Factors associated with FI were analyzed. RESULTS A total of 319 consecutive patients with IBD were included. The prevalence of FI was 16.4% (53/319). Age >45 years at inclusion (Odd ratio (OR)=3.33, Confidence interval (CI) 95% 1.40-7.94), diarrhea (three stools at least per day) (OR=2.94, CI 95% 1.16-7.45), stool consistency according to the Bristol stool chart (OR=2.23, CI 95% 1.00-4.99), and abdominal pain (OR=2.24, CI 95% 1.10-4.53) were independently associated with FI in a multivariate model analysis. CONCLUSIONS Approximately one fifth of IBD patients reported FI in this real-world cohort, using an available scoring system. Increased age, diarrhea, stool consistency according to the Bristol stool chart, and abdominal pain were associated with FI. A systematic screening of FI would allow a better management of this disabling condition.
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Affiliation(s)
- Simon Kurt
- Nancy University Hospital, Department of Gastroenterology, F-54000 Nancy, France
| | - Bénédicte Caron
- Nancy University Hospital, Department of Gastroenterology, F-54000 Nancy, France; Nancy University Hospital, DRCI, F-54000 Nancy, France
| | - Celia Gouynou
- Nancy University Hospital, Department of Gastroenterology, F-54000 Nancy, France
| | - Patrick Netter
- Ingénierie Moléculaire et Ingénierie Articulaire (IMoPA), UMR-7365 CNRS, Faculté de Médecine, University of Lorraine and University Hospital of Nancy, Vandoeuvre-lès-Nancy, France
| | - Carolynne J Vaizey
- Ingénierie Moléculaire et Ingénierie Articulaire (IMoPA), UMR-7365 CNRS, Faculté de Médecine, University of Lorraine and University Hospital of Nancy, Vandoeuvre-lès-Nancy, France; Department of Surgery, St Mark's Hospital and Academic Institute, London, United Kingdom; Department of Surgery and Cancer, Imperial College, London, United Kingdom
| | - Steven D Wexner
- Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, FL, United States
| | - Silvio Danese
- Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, FL, United States; Gastroenterology and Endoscopy, IRCCS Ospedale San Raffaele and University Vita-Salute San Raffaele Milano Italy
| | - Cédric Baumann
- Unit of methodology, data management and statistic, Nancy University Hospital, Vandoeuvre-lès-Nancy, France
| | - Laurent Peyrin-Biroulet
- Nancy University Hospital, Department of Gastroenterology, F-54000 Nancy, France; University of Lorraine, Inserm, NGERE, F-54000 Nancy, France.
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Chen ZW, Zheng Y, Zhao R, Wang ZJ. Treatment of anal fistula using a decellularized porcine small intestinal submucosa plug: A non-inferiority trial. Medicine (Baltimore) 2022; 101:e29110. [PMID: 35866804 PMCID: PMC9302366 DOI: 10.1097/md.0000000000029110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 03/01/2022] [Accepted: 03/01/2022] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Using small intestinal submucosa (SIS) has increasingly become the standard method for the treatment of anal fistula. The porcine SIS manufactured by Biosis Healing is a novel biological material that has several advantages for the safe and effective repair of tissues. Our study aimed to verify the efficacy and safety of the decellularized porcine SIS (VIDASIS) anal fistula plug. METHODS We conducted a non-inferiority multicenter, randomized, controlled clinical trial involving patients with chronic anal fistula. Patients from 3 centers across China were randomized 1:1 to Biosis SIS vs commercial SIS. The primary endpoint was the healing rate and secondary endpoints included recurrence within 6 months, rate of copracrasia, healing time, pain using a visual analog scale, and patient and doctor satisfaction. RESULTS A total of 186 patients were randomized. Of these, 82 patients in the Biosis SIS and 81 in the control (commercial) SIS completed the trial (per-protocol set). The healing rate at the 6-month follow-up (full analysis set) was 92.0% for the Biosis SIS and 89.8% for the control SIS (P = .620). The rate difference of 2.2% (full analysis set; 95% confidence interval: -6.4% and 10.7%, respectively) was within the pre-specified non-inferiority margin of -10%. There were no differences between the 2 groups with regard to the secondary endpoints. No serious adverse event or death occurred. CONCLUSION Our study shows that the VIDASIS anal fistula plug manufactured by the company Biosis Healing is safe and effective and is not inferior to existing commercial SIS materials.
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Affiliation(s)
- Zhao Wen Chen
- Department of General Surgery, Peking University Third Hospital, Beijing, China
| | - Yi Zheng
- Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Rong Zhao
- Tianjin People's Hospital, Tianjin, China
| | - Zhen Jun Wang
- Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
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Paganotti B, Miasato M, Morais MBD, Tahan S. THE FATIGUE RATE INDEX IS HIGHER IN CHILDREN WITH FUNCTIONAL CONSTIPATION AND RETENTIVE FECAL INCONTINENCE. Arq Gastroenterol 2022; 59:428-433. [PMID: 36102443 DOI: 10.1590/s0004-2803.202203000-76] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 06/22/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND The Fatigue Rate Index (FRI) is a parameter in anorectal manometry (ARM) to assess sustained voluntary contraction, considering the squeeze pressure and fatigability of the external anal sphincter. It is used in adults to detect fecal incontinence even in patients who present normal squeeze pressures. The FRI in adult patients with functional constipation is similar to controls. OBJECTIVE The aim of this study was to evaluate the feasibility and values of FRI in children in relation to the values previously established in adults and comparing children with functional constipation and retentive fecal incontinence to children without retentive fecal incontinence. METHODS This retrospective study evaluated 105 ARM performed from Jan 2014 to Apr 2015. 42 patients were selected (were able to perform a voluntary contraction and had no co-morbidities other than functional constipation). 14 (33.3%) of those collaborated in sustaining contraction for 40 seconds (s), allowing the evaluation of the FRI. Patients with retentive fecal incontinence secondary to functional constipation (n=7, aged 6 to 13 years, six boys) were our interest group. Patients with functional constipation without fecal incontinence (n=7, aged 6 to 13 years, four boys) were considered a reference group. The ARM were performed with a radial eight-channel perfusion catheter (DynamedTM, São Paulo, Brazil) and the FRI was calculated (Proctomaster 6.4) in the first 20 s and overall 40 s of sustained voluntary contraction. RESULTS 14 of the selected 42 collaborated in sustaining contraction for 40 s, allowing the evaluation of the FRI. In the first 20 s of contraction, the fecal incontinence group showed a significantly higher mean FRI (2.48±1.39 min) compared to the reference group (1.13±0.72 min, P=0.042), which was not observed in the 40 s interval due to less uniform contraction. The anal resting pressure was higher in the fecal incontinence group (76.83 mmHg) than in the reference group (54.13 mmHg), but the statistical study did not reach significance (P=0.051). CONCLUSION The FRI is feasible in children. The mean FRI obtained in this study is lower than the reported in constipated adults. The mean FRI among children with functional constipation and retentive fecal incontinence is higher than among constipated children without retentive fecal incontinence.
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Affiliation(s)
- Bruno Paganotti
- Universidade Federal de São Paulo, Departamento de Pediatria, Disciplina de Gastroenterologia Pediátrica, São Paulo, SP, Brasil
| | - Marcio Miasato
- Universidade Federal de São Paulo, Departamento de Pediatria, Disciplina de Gastroenterologia Pediátrica, São Paulo, SP, Brasil
| | - Mauro Batista de Morais
- Universidade Federal de São Paulo, Departamento de Pediatria, Disciplina de Gastroenterologia Pediátrica, São Paulo, SP, Brasil
| | - Soraia Tahan
- Universidade Federal de São Paulo, Departamento de Pediatria, Disciplina de Gastroenterologia Pediátrica, São Paulo, SP, Brasil
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Zhang X, Wang X, Zhao X, Zhang Y. A Structured Skin Care Protocol for Preventing and Treating Incontinence-associated Dermatitis in Critically Ill Patients. Adv Skin Wound Care 2022; 35:335-342. [PMID: 35703853 DOI: 10.1097/01.asw.0000828972.70137.8a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To examine the effectiveness of a structured skin care protocol for preventing and treating incontinence-associated dermatitis (IAD) in critically ill patients. METHODS Participants were drawn from the ICUs of three teaching hospitals between January 2016 and December 2017. Patients were eligible if they were ≥18 years old, had idiopathic fecal incontinence, had diarrhea but were unable to sense it, and were expected to stay in the ICU for at least 72 hours after developing incontinence. A total of 143 patients were enrolled: 79 in the experimental group and 64 in the control group. In the first phase of the study, routine skin care measures were used; in the second phase, three ICU caregivers were trained to provide a structured skin care protocol. Trained research team members conducted the data collection and analysis. The TREND (Transparent Reporting of Evaluations with Nonrandomized Designs) Statement Checklist was followed in reporting the study results. RESULTS Application of the structured skin care protocol reduced the incidence of IAD from 35.9% in the control phase to 17.7% in the intervention phase (χ2 = 6.117, P < .05) and also decreased the severity of IAD (z = -2.023, P < .05). Further, IAD developed later (z = -2.116, P < .05) in the intervention group than in the control group. In addition, the nursing times to prevent or manage IAD did not differ significantly between the groups (t = -0.258, P > .05; t = -1.190, P > .05). CONCLUSIONS Use of the developed structured skin care protocol for IAD in critically ill patients lowered the incidence and severity of IAD and delayed IAD development.
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Affiliation(s)
- Xiaoxue Zhang
- In the General Surgery Department at Xuanwu Hospital, Capital Medical University, Beijing, China, Xiaoxue Zhang is Nurse; Xinran Wang is Head Nurse and Professor; and Xiaowei Zhao is Head Nurse. Yu Zhang is Nurse, Urinary Surgery Department, Beijing Hospital. Acknowledgments: This work was supported by the Beijing Municipal Administration of Hospitals Incubating Program (grant PX2016037) and the Chinese Nursing Association Project (grant ZHKY201711). The authors gratefully acknowledge the financial support of the Beijing Municipal Administration of Hospitals Incubating Program and Chinese Nursing Association Project. They also thank the nurses in three ICUs for their effort in the protocol implementation. The authors have disclosed no other financial relationships related to this article. Submitted May 6, 2021; accepted in revised form July 23, 2021
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Fogle SE, Donahue CA, Beresneva O, Kuhnen AH, Kleiman DA, Breen EM, Schoetz DJ, Roberts PL, Marcello PW, Saraidaridis JT. Horseshoe Fistulae in the Age of LIFT. J Gastrointest Surg 2022; 26:1077-1083. [PMID: 35064458 DOI: 10.1007/s11605-021-05233-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 12/07/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND Horseshoe fistula is a challenging benign anorectal condition to treat. The aim of this study was to assess the utilization and success of different definitive fistula repair techniques in the treatment of horseshoe fistula. METHODS This was a retrospective case series which included all patients who were treated for horseshoe fistula from 2006 to 2019 at a single, tertiary care center and whom had at least one follow-up visit. Patients were excluded if < 18 years of age or carried a diagnosis of Crohn's disease. Patients were assessed for fistula recurrence and incontinence. RESULTS Sixty-eight patients were identified. On average, they were 47 years old, 63% male, and 18% current smokers. Seventy-nine percent required seton during their treatment course. Of the 8 first attempts at fistula repair, the types of repair included flap (15%), LIFT (35%), fistulotomy (31%), plug (12%), and fistulotomy and immediate reconstruction (1%). Recurrence for these procedures was as follows: flap 30%, LIFT 21%, fistulotomy 14%, plug 88%, and fistulotomy and immediate reconstruction 0%. Twelve patients who recurred underwent 17 additional procedures to attempt to cure their fistula. Overall, of those who underwent any attempt at definitive repair, 82% of patients were cured of their fistula, 12% had a chronic seton, and 6% had a chronic fistula. Thirteen percent of those who were cured had incontinence. The mean follow-up time was 1.1 years. Patients required a median of 3 procedures (range 1-11). CONCLUSION Horseshoe fistula remains a complex anorectal condition. Successful repair can be performed in > 80% of patients. However, repair can often require multiple surgical procedures.
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Affiliation(s)
- Sydney E Fogle
- Division of Colon and Rectal Surgery, Lahey Hospital and Medical Center, 41 Mall Road, Burlington, MA, 01805, USA
| | - Colleen A Donahue
- Division of Colon and Rectal Surgery, Medical University of South Carolina, 171 Ashley Ave., Charleston, SC, 29405, USA
| | - Olga Beresneva
- Division of Colon and Rectal Surgery, Boston Medical Center, 830 Harrison Ave, 2nd Floor, Boston, MA, 02118, USA
| | - Angela H Kuhnen
- Division of Colon and Rectal Surgery, Lahey Hospital and Medical Center, 41 Mall Road, Burlington, MA, 01805, USA
| | - David A Kleiman
- Division of Colon and Rectal Surgery, Lahey Hospital and Medical Center, 41 Mall Road, Burlington, MA, 01805, USA
| | - Elizabeth M Breen
- Division of Colon and Rectal Surgery, Lahey Hospital and Medical Center, 41 Mall Road, Burlington, MA, 01805, USA
| | - David J Schoetz
- Division of Colon and Rectal Surgery, Lahey Hospital and Medical Center, 41 Mall Road, Burlington, MA, 01805, USA
| | - Patricia L Roberts
- Division of Colon and Rectal Surgery, Lahey Hospital and Medical Center, 41 Mall Road, Burlington, MA, 01805, USA
| | - Peter W Marcello
- Division of Colon and Rectal Surgery, Lahey Hospital and Medical Center, 41 Mall Road, Burlington, MA, 01805, USA
| | - Julia T Saraidaridis
- Division of Colon and Rectal Surgery, Lahey Hospital and Medical Center, 41 Mall Road, Burlington, MA, 01805, USA.
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Hill B, Mitchell A. Transanal irrigation at a glance. Br J Nurs 2022; 31:308-314. [PMID: 35333548 DOI: 10.12968/bjon.2022.31.6.308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
This article provides a brief overview of transanal irrigation (TAI). It covers the rationale behind the procedure, the contraindications, possible complications and considerations for patient education and support.
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Affiliation(s)
- Barry Hill
- Director of Nursing Midwifery and Health Employability, Northumbria University, Newcastle upon Tyne
| | - Aby Mitchell
- Professional Lead for Simulation and Immersive Technologies, University of West London, London
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Igbedioh C. Transanal irrigation therapy: selection and support are the keys to success. Br J Nurs 2022; 31:306. [PMID: 35333554 DOI: 10.12968/bjon.2022.31.6.306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Affiliation(s)
- Carlene Igbedioh
- Integrated Continence Advanced Nurse Practitioner/Lead Nurse, Guy's and St Thomas' NHS Foundation Trust
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O’Connell S, Dale M, Morgan H, Dillon B, Cleves A, Morris R, Carolan-Rees G. Episcissors-60 for Mediolateral Episiotomy: Evaluation of Clinical and Economic Evidence to Inform NICE Medical Technologies Guidance. Appl Health Econ Health Policy 2022; 20:159-169. [PMID: 34782994 PMCID: PMC8847176 DOI: 10.1007/s40258-021-00695-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 10/21/2021] [Indexed: 06/13/2023]
Abstract
Obstetric anal sphincter injury (OASI) occurs in 2.9% of all vaginal births in the UK and can result in faecal incontinence. Where there is a clinical need for episiotomy, OASI can be minimised by accurate selection of the optimum angle of mediolateral episiotomy. Episcissors-60 are adapted surgical scissors incorporating a guide-limb to help achieve an accurate angle of mediolateral episiotomy. The ability of Episcissors-60 to reduce OASI by preventing inaccurate visual estimates of episiotomy angles was considered by the National Institute of Health and Care Excellence (NICE) as part of the Medical Technologies Evaluation Programme (MTEP). NICE concluded that Episcissors-60 shows promise for mediolateral episiotomy both in terms of clinical effectiveness and potential cost savings, but that there was not enough evidence to support routine adoption into the NHS at this time. NICE MTG47 recommends that key gaps in the evidence including patient-reported outcomes and the addition of Episcissors-60 to care bundles be addressed through research with specific focus on potential equality considerations.
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Affiliation(s)
- Susan O’Connell
- Cedar, Cardiff and Vale University Health Board, Cardiff, UK
| | - Megan Dale
- Cedar, Cardiff and Vale University Health Board, Cardiff, UK
| | | | - Bernice Dillon
- National Institute for Health and Care Excellence, Manchester, UK
| | - Andrew Cleves
- Cedar, Cardiff and Vale University Health Board, Cardiff, UK
| | - Rhys Morris
- Cedar, Cardiff and Vale University Health Board, Cardiff, UK
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Menees SB, Jackson K, Baker JR, Fenner DE, Eswaran S, Nojkov B, Saad R, Lee AA, Chey WD. A Randomized Pilot Study to Compare the Effectiveness of a Low FODMAP Diet vs Psyllium in Patients With Fecal Incontinence and Loose Stools. Clin Transl Gastroenterol 2022; 13:e00454. [PMID: 35060943 PMCID: PMC8963855 DOI: 10.14309/ctg.0000000000000454] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 12/06/2021] [Indexed: 12/05/2022] Open
Abstract
INTRODUCTION The aim of the study was to compare the effectiveness of a low fermentable oligosaccharide, disaccharide, monosaccharide, and polyol diet (LFD) vs psyllium on the frequency and severity of fecal incontinence (FI) episodes in patients with loose stools. METHODS This was a single-center, randomized pilot trial of adult patients with FI (Rome III) with at least 1 weekly FI episode associated with loose stool. Eligible patients were randomized to 4 weeks of either a dietitian-led LFD or 6 g/d psyllium treatment. RESULTS Forty-three subjects were randomized from October 2014 to May 2019. Thirty-seven patients completed the study (19 LFD and 18 psyllium). There was no statistically significant difference in the proportion of treatment responders (>50% reduction in FI episodes compared with baseline) for treatment weeks 1-4 (LFD 38.9%, psyllium 50%, P = .33). Compared with baseline, mean fecal incontinence severity index score significantly improved with LFD (39.4 vs 32.6, P = .02) but not with psyllium (35.4 vs 32.1, P = .29). Compared with baseline values, the LFD group reported improvements in fecal incontinence quality of life coping/behavior, depression/self-perception, and embarrassment subscales. The psyllium group reported improvement in incontinence quality of life coping/behavior. DISCUSSION In this pilot study, there was no difference in the proportion of patients who reported a 50% reduction of FI episodes with the LFD or psyllium. Subjects in the psyllium group reported a greater reduction in overall FI episodes, whereas the LFD group reported consistent improvements in FI severity and quality of life. Further work to understand these apparently discrepant results are warranted but the LFD and psyllium seem to provide viable treatment options for patients with FI and loose stools.
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Affiliation(s)
- Stacy B. Menees
- Division of Gastroenterology, Michigan Medicine, Ann Arbor, Michigan, USA
- Division of Gastroenterology, Department of Internal Medicine, Ann Arbor Veterans Affairs Medical Center, Ann Arbor, Michigan, USA
| | - Kenya Jackson
- Children's Healthcare of Atlanta Aflac Blood and Cancer Disorders Center, Atlanta, Georgia, USA; and
| | - Jason R. Baker
- Division of Gastroenterology, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Dee E. Fenner
- Department of Obstetrics and Gynecology, Michigan Medicine, Ann Arbor, Michigan, USA.
| | - Shanti Eswaran
- Division of Gastroenterology, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Borko Nojkov
- Division of Gastroenterology, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Richard Saad
- Division of Gastroenterology, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Allen A. Lee
- Division of Gastroenterology, Michigan Medicine, Ann Arbor, Michigan, USA
| | - William D. Chey
- Division of Gastroenterology, Michigan Medicine, Ann Arbor, Michigan, USA
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Khan MA, Ullah R, Kamran H, Zarin M. Vaaft (Video Assisted Anal Fistula Treatment); Novel Technique For The Treatment Of Anal Fistula. J Ayub Med Coll Abbottabad 2022; 34:8-11. [PMID: 35466618 DOI: 10.55519/jamc-01-8815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND VAAFT (Video Assisted Anal Fistula Treatment) is a novel minimally invasive technique for treatment of Fistula in Ano, which claims superior results compared to current treatment modalities due to the added advantage of real time visualization of the fistula tract and internal opening of the fistula using a fistuloscope. METHODS This is cross sectional study in which 84 patients were selected using consecutive non probability sampling. They underwent VAAFT and were followed to assess for primary healing and continence at 6 weeks, and recurrence at 1 year. RESULTS In this study, 97.6% participants were male. Mean operating time was 24 minutes while Mean VAS was 3.7±2.2. Healing was observed in 83.2% whereas recurrence was found in 10% at one year. All of the patients had normal sphincteric function post operatively. CONCLUSIONS The results of our study affirm other studies in terms of cure rates, sphincter preservation and fistula recurrence. Studies with larger sample size and long term follow up are required to establish the superiority of VAAFT over the other currently available treatment options for anal fistula.
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Affiliation(s)
| | - Rafat Ullah
- Department of Surgery, Ayub Teaching Hospital, Abbottabad, Pakistan
| | - Haider Kamran
- Department of Surgery, Ayub Teaching Hospital, Abbottabad, Pakistan
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Dai QQ, Shao QS, Jiang ML, Chen BC, Gong WJ. [Efficacy of Altemeier operation combined with autogenous anal sphincter constriction in 40 patients with degree II and III rectal prolapse and anal loosening]. Zhonghua Wei Chang Wai Ke Za Zhi 2021; 24:1116-1118. [PMID: 34923799 DOI: 10.3760/cma.j.cn441530-20200615-00359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
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Abstract
Low anterior resection syndrome (LARS) is a collection of symptoms that can occur as a result of a low anterior resection for bowel cancer. Transanal irrigation (TAI) can be used to manage these symptoms. This article describes a retrospective audit of 15 patients who were using TAI to manage symptoms of LARS. The aim of the audit was to ascertain whether the use of TAI improved outcomes for these patients. The data suggest that TAI has reduced both the frequency of bowel movements and episodes of faecal incontinence. Those patients using higher volumes of water seem to have experienced more benefit than those patients using lower volumes of water. These findings are consistent with current literature around TAI for LARS and suggest research into optimum volume of water would be beneficial.
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Affiliation(s)
- Rebecca Embleton
- Bowel Dysfunction Specialist Nurse, Durham Bowel Dysfunction Service, County Durham and Darlington NHS Foundation Trust
| | - Michelle Henderson
- Academic Clinical Nurse Specialist, Durham Bowel Dysfunction Service, County Durham and Darlington NHS Foundation Trust
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Perivoliotis K, Baloyiannis I, Ragias D, Beis N, Papageorgouli D, Xydias E, Tepetes K. The role of percutaneous tibial nerve stimulation (PTNS) in the treatment of chronic anal fissure: a systematic review. Int J Colorectal Dis 2021; 36:2337-2346. [PMID: 34132862 DOI: 10.1007/s00384-021-03976-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/08/2021] [Indexed: 02/04/2023]
Abstract
PURPOSE This study was designed to summarize the current evidence regarding the role of percutaneous tibial nerve stimulation (PTNS) in the treatment of chronic anal fissure (CAF). METHODS The present systematic review of the literature was conducted on the basis of the PRISMA guidelines and the Cochrane Handbook for Systematic Reviews of Interventions. The primary endpoint of our study was the CAF recurrence rate. Quality assessment was based on the RoB 2 tool and the Case Series Quality Checklist. RESULTS Overall, 5 studies and 102 patients were included. A considerably heterogeneity in the neuromodulation technique and setting was identified. The pooled recurrence rate was estimated at the level of 19% (16/84). Post-interventional pain and Wexner scores were considerably reduced. The 2-month healing rate was 72% (18/25), whereas 73.6% of patients were symptom-free at 6 months. CONCLUSIONS PTNS is an effective alternative for the non-operative management of CAF. Due to several limitations further larger and higher quality studies are required.
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Affiliation(s)
| | - Ioannis Baloyiannis
- Department of Surgery, University Hospital of Larissa, Mezourlo, 41110, Larissa, Greece
| | - Dimitrios Ragias
- Faculty of Medicine, University of Thessaly, Mezourlo, 41110, Larissa, Greece
| | - Nikolaos Beis
- Faculty of Medicine, University of Thessaly, Mezourlo, 41110, Larissa, Greece
| | | | - Emmanouil Xydias
- Faculty of Medicine, University of Thessaly, Mezourlo, 41110, Larissa, Greece
| | - Konstantinos Tepetes
- Department of Surgery, University Hospital of Larissa, Mezourlo, 41110, Larissa, Greece
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Guldbrandsen K, Kousgaard SJ, Bjørk J, Glavind K. Patient goals after operation in the posterior vaginal compartment. Eur J Obstet Gynecol Reprod Biol 2021; 267:23-27. [PMID: 34689023 DOI: 10.1016/j.ejogrb.2021.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 10/07/2021] [Accepted: 10/10/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Success after operation for a pelvic organ prolapse in the posterior vaginal compartment is often related to restoration of anatomy, but success for the patient is linked to achievement of patient-reported goals. We investigated patient-reported goals after an operation in the posterior compartment and to which extent the goals had been achieved. STUDY DESIGN A prospective case series study including 87 women undergoing operation in the posterior compartment at Aalborg University Hospital. The women were asked to list up to three goals they wished to fulfil with the operation. Three months after surgery a telephone interview was conducted in which the women were asked whether each single goal was fulfilled, partly fulfilled or not fulfilled and to estimate the extent to which the goals had been achieved on a VAS scale from 1 to 10. RESULTS All patient-reported goals were divided into eight groups: 1: bulging, 2: bowel problems, 3: urinary problems, 4: sexual problems, 5: psychological problems, 6: physical activity, 7: pain and 8: others. A total of 233 goals were stated. Most goals were related to bowel problems (37.3%) and bulging (21.0%). Median total VAS score was 9. Overall 58.8% of all goals were categorized as fulfilled and 22.3% as partly fulfilled. Fulfilled goals were 83.7% in the group with bulging problems, sexuality problems 65%, and bowel problems 57.5%. Urinary problems had fewest fulfilled goals (18.5%). Bowel problems were further divided into evacuation problems, incontinence, constipation and others. Goals concerning evacuation problems were most often fulfilled (76.1%), and goals concerning anal incontinence were rarely fulfilled (25.0%). CONCLUSIONS Approximately 80% of the patient-reported goals after posterior compartment operation were fulfilled or partly fulfilled. Most goals were related to bowel problems and bulging. Bowel problems in the form of evacuation problems were more often solved than incontinence and constipation, and women should be advised about this. All goals should be discussed with the patient prior to an operation.
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Affiliation(s)
- Karen Guldbrandsen
- Department of Obstetrics and Gynaecology, Aalborg University Hospital, Reberbansgade, 9000 Aalborg, Denmark.
| | - Sabrina Just Kousgaard
- Department of Obstetrics and Gynaecology, Aalborg University Hospital, Reberbansgade, 9000 Aalborg, Denmark
| | - Jonna Bjørk
- Department of Obstetrics and Gynaecology, Aalborg University Hospital, Reberbansgade, 9000 Aalborg, Denmark
| | - Karin Glavind
- Department of Obstetrics and Gynaecology, Aalborg University Hospital, Reberbansgade, 9000 Aalborg, Denmark
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Yilmaz EŞ, Büyük ET. Effect of education given to children with enuresis on quality of life. J Pediatr Urol 2021; 17:648.e1-648.e7. [PMID: 34518125 DOI: 10.1016/j.jpurol.2021.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 06/28/2021] [Accepted: 08/02/2021] [Indexed: 11/18/2022]
Abstract
INTRODUCTION The quality of life of children diagnosed with enuresis is affected negatively compared with that of healthy children. OBJECTIVES This study aimed to evaluate the effect of the education program given within the framework of nursing activities on the quality of life of children diagnosed with enuresis. STUDY DESIGN The study was conducted on 60 children aged 7-12 years who applied to the urology clinic of a hospital in Turkey and were diagnosed with enuresis. Data were collected using the Pediatric Incontinence Questionnaire (PINQ). Children who met the study criteria were divided into two groups, control and experimental, using the random draw method. Participants in the experimental group were educated by the researcher with using the Enuresis Education Booklet. RESULTS Of the 60 children, 43.3% were aged 7-8 years and 63.3% were male. At baseline, the children in the control group revealed a total mean PINQ score of 45.00 ± 11.52, and the total mean PINQ score was 45.80 ± 12.05 at 1 month. At baseline, the children in the experimental group revealed a total mean PINQ score of 47.00 ± 11.88, and the total mean PINQ score of was 32.404 ± 8.62 at 1 month. A measurement carried out in the education and control groups 1 month later showed a statistically significant difference in the total mean PINQ scores (P < 0.001). CONCLUSION Explaining the disease thoroughly to a child created a positive effect on the child's quality of life.
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Affiliation(s)
| | - Esra Tural Büyük
- Department of Child Health Nursing, Faculty of Health Sciences, Ondokuz Mayıs University, Samsun, Turkey.
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Dawka S, Yagnik VD. Comparison Between the Modified Parks and Garg Classifications of Cryptoglandular Anal Fistulas. Dis Colon Rectum 2021; 64:e589. [PMID: 34310514 DOI: 10.1097/dcr.0000000000002208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
| | - Vipul D Yagnik
- Nishtha Surgical Hospital and Research Centre, Patan, Gujarat, India
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D'Orazio B, Geraci G, Bonventre S, Calì D, Di Vita G. Safety and effectiveness of saving sphincter procedure in the treatment of chronic anal fissure in female patients. BMC Surg 2021; 21:350. [PMID: 34560857 PMCID: PMC8461903 DOI: 10.1186/s12893-021-01346-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 09/13/2021] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Lateral internal sphincterotomy (LIS) is still the approach of choice for the treatment of chronic anal fissure (CAF) regardless to the internal anal sphincter tone but it is burdened by high risk post-operative faecal incontinence (FI). In female patient there are some anatomical and functional differences of the sphinteric system which make them more at risk of FI and vaginal birth could cause sphinteric lesions affecting the anal continence function. The aim of our study is to evaluate the results of saving sphincter procedure as treatment for female patients affected by CAF. METHODS We studied 110 female patients affected by CAF undergone fissurectomy and anoplasty with V-Y cutaneous flap advancement associating pharmacological sphincterotomy in patients with hypertonic IAS. The follow up was at least for 2 years. The goals were patient's complete healing, the evaluation of FI, recurrence rate and manometry parameters. RESULTS All wounds healed within 40 days after surgery. We recorded 8 cases of recurrences 6 healed with medical therapy and 2 with dilatation. We recorded 2 "de novo" temporary and low grade post-operative cases of FI. Post-operative value of MRP were unmodified in patient with normotonic IAS but significantly lower at 12 months follow up as compared with the pre-operative ones in patients with hypertonic IAS; after 24 months from surgery MRP values were within the normal range. CONCLUSION The fissurectomy and anoplasty with V-Y cutaneous flap alone or in association with a pharmacological sphincterotomy in patients with hypertonic IAS may represent an effective approach for the treatment of CAF in female patients.
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Affiliation(s)
- Beatrice D'Orazio
- General Surgery Unit, Department of Surgical, Oncological and Stomatological Sciences, University of Palermo, Via Liborio Giuffrè, 5, 90127, Palermo, Italy
| | - Girolamo Geraci
- General Surgery Unit, Department of Surgical, Oncological and Stomatological Sciences, University of Palermo, Via Liborio Giuffrè, 5, 90127, Palermo, Italy
| | - Sebastiano Bonventre
- General Surgery Unit, Department of Surgical, Oncological and Stomatological Sciences, University of Palermo, Via Liborio Giuffrè, 5, 90127, Palermo, Italy
| | - Dario Calì
- General Surgery Unit, Department of Surgical, Oncological and Stomatological Sciences, University of Palermo, Via Liborio Giuffrè, 5, 90127, Palermo, Italy
- Postgraduate Medical School in General Surgery, University of Palermo, Palermo, Italy
| | - Gaetano Di Vita
- General Surgery Unit, Department of Surgical, Oncological and Stomatological Sciences, University of Palermo, Via Liborio Giuffrè, 5, 90127, Palermo, Italy.
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Carpelan A, Elamo E, Karvonen J, Varpe P, Elamo S, Vahlberg T, Grönroos J, Huhtinen H. Validation of the low anterior resection syndrome score in finnish patients: preliminary results on quality of life in different lars severity groups. Scand J Surg 2021; 110:414-419. [PMID: 32552563 PMCID: PMC8551436 DOI: 10.1177/1457496920930142] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 05/05/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND AIMS Low anterior resection syndrome is common after anterior resection for rectal cancer. Its severity can be tested with the low anterior resection syndrome score. We have translated the low anterior resection syndrome score to Finnish, and the aim of this study is to validate the translation. MATERIALS AND METHODS The translated Finnish low anterior resection syndrome score and European Organisation for Research and Treatment of Cancer quality-of-life questionnaire-C30 and QLQ-CR29 questionnaires were sent to 159 surviving patients operated with anterior resection for rectal adenocarcinoma between 2007 and 2014 in a tertiary referral center. Psychometric properties of the translation were evaluated in comparison to quality-of-life scales and in different risk factor groups. RESULTS In the study, 104 (65%) patients returned the questionnaires. Of these, 56 (54%) had major low anterior resection syndrome, 26 (25%) had minor low anterior resection syndrome, and 22 (21%) had no low anterior resection syndrome. Patients with major low anterior resection syndrome had a significantly lower quality of life and more defecatory symptoms as assessed with the European Organisation for Research and Treatment of Cancer questionnaires compared with those with no low anterior resection syndrome. Patients operated with total mesorectal excision had significantly higher low anterior resection syndrome scores compared with those operated with partial mesorectal excision (median/interquartile range 32/15 and 29/11, respectively, p = 0.037). The test-retest validity of the translation was good with an intraclass correlation coefficient of 0.77 (95% confidence interval 0.51-0.90). CONCLUSIONS The Finnish low anterior resection syndrome score is a valid test in the assessment of postoperative bowel function and its impact on the quality of life. It can be implemented to use during regular follow-up visits of Finnish-speaking rectal cancer patients.
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Affiliation(s)
- Anu Carpelan
- Department of Digestive Surgery, Turku University Hospital, Kiinamyllynkatu 4-8, Turku, 20520, Finland
| | - Eeva Elamo
- Department of Digestive Surgery, Turku University Hospital, University of Turku, Turku, Finland
| | - Jukka Karvonen
- Department of Digestive Surgery, Turku University Hospital, University of Turku, Turku, Finland
| | - Pirita Varpe
- Department of Digestive Surgery, Turku University Hospital, University of Turku, Turku, Finland
| | - Sami Elamo
- Department of Orthopaedics, Satakunta Central Hospital, Pori, Finland and University of Turku, Turku, Finland
| | - Tero Vahlberg
- Biostatistics, Department of Clinical Medicine, University of Turku, Turku, Finland
| | - Juha Grönroos
- Department of Digestive Surgery, Turku University Hospital, University of Turku, Turku, Finland
| | - Heikki Huhtinen
- Department of Digestive Surgery, Turku University Hospital, University of Turku, Turku, Finland
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