Fecal incontinence after total mesorectal excision for rectal cancer—impact of potential risk factors and pelvic intraoperative neuromonitoring

Kauff, Daniel W.; Roth, Yvonne D. S.; Bettzieche, R.; Kneist, W.

doi:10.1186/s12957-020-1782-6

Cited by 21 publications

(13 citation statements)

References 22 publications

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“…Kauff and Kneist et al, who have published research on pelvic neuromonitoring since 2011, have also reported the usage of the stimulation frequency of 30 Hz in several studies. Stimulation currents in the range of 1–25 mA were described 19 , whereby a current of 6 mA was applied in most studies 20 , 21 , 26 , which also corresponds to the approach in this study.…”

Section: Discussionmentioning

confidence: 99%

“…A series of studies has been published fby the research group Kauff and Kneist et al 15 , 20 , 23 . Recently published studies indicate that pelvic intraoperative neuromonitoring performed with cystomanometry and EMG of the IAS is associated with lower rates of new-onset urinary dysfunction and fecal incontinence 21 , 26 . The practical application of this method requires filling the urinary bladder with Ringer’s solution for cystomanometry and precise positioning of the electrodes on the internal anal sphincter, which has to be performed under endosonography in case needle electrodes are used 29 .…”

Section: Discussionmentioning

confidence: 99%

“…Due to the different contraction and excitation behavior of motor and smooth muscles, a different measurement technique consisting of signal amplification and signal processing is required, the EMG method for motor muscles is not suitable for smooth muscles. The research group Kauff and Kneist et al investigated and developed a method for intraoperative neuromonitoring of pelvic autonomic nerves based on adapted smooth muscle EMG measurement in combination with bladder manometry 19 – 21 . This is the only method on the market that has the same intended purpose as the method presented in this study.…”

Section: Introductionmentioning

confidence: 99%

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A new method of intraoperative pelvic neuromonitoring: a preclinical feasibility study in a porcine model

Schuler

Goos

Langer³

et al. 2022

Sci Rep

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Low anterior resections (LAR) are frequently associated with complications such as urinary and fecal incontinence as well as sexual disorders. Typical risk factors are rectal cancer with low tumor location, preoperative radiotherapy, and surgery-related damage of pelvic autonomic nerves. As preserving the pelvic autonomic nerves without any technical assistance is challenging, the objective of this preclinical study was to investigate the technical feasibility of a new method for intraoperative pelvic neuromonitoring. Twelve female pigs undergoing low anterior resections were involved in a prospective preclinical study. Intraoperative pelvic neuromonitoring included direct pelvic nerve stimulation and tissue impedance measurement on the urinary bladder and the rectum for the identification of efferent pelvic nerves in the surgical area. Immunohistochemistry was used to verify the results. Smooth muscle contraction of the urinary bladder and/or the rectum in response to direct stimulation of the innervating nerves was detectable with impedance measurement. The macroscopic contraction of both the urinary bladder and the rectum correlated with a change in tissue impedance compared to the status before contraction. Thus, it was possible to identify pelvic nerves in the surgical area, which allows the nerves to be preserved. The results indicate a reliable identification of pelvic autonomic nerves, which allows nerve damage to be prevented in the future.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

A new method of intraoperative pelvic neuromonitoring: a preclinical feasibility study in a porcine model

Schuler

Goos

Langer³

et al. 2022

Sci Rep

View full text Add to dashboard Cite

show abstract

“…In the light of these considerations, to improve the QOL of patients submitted to CRS plus HIPEC, it is important to not only cure the psychological aspect but also reduce the consequences of the pelvic innervation related to the pelvic peritonectomy. For this reason, based on the well-coded experiences in rectal surgery [ 4 ], [ 10 ], [ 11 ], we decided to apply IONM to CRS plus HIPEC. We retain that IONM is technically feasible during peritonectomy and that it can help preserve pelvic nerves.…”

Section: Discussionmentioning

confidence: 99%

Technique of neuromonitoring during pelvic peritonectomy

Macrì

Badessi

Mazzeo

et al. 2020

Pleura and Peritoneum

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ObjectivesPelvic peritonectomy can induce anorectal and urogenital dysfunctions. To reduce this type of complications during the procedure, we propose to use intraoperative neuromonitoring (IONM).ContentStimulation with a bipolar probe allows the identification of the obturator and ilioinguinal and pudendal nerves. At the end of the cytoreductive surgery, the motor and somatosensory evoked potentials must be evaluated to confirm the preservation of pelvic innervation.SummaryThe use of IONM during pelvic peritonectomy is technically feasible, and it can help to preserve pelvic nerves.OutlookObviously, its definitive value remains to be elucidated.

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“…Kauff et al compared pelvic IONM during TME with a control group and demonstrated the less new onset of faecal incontinence in the neuromonitoring group at each follow-up (3, 6. 12 and 24 months) [ 123 ]. Zhou et al demonstrated no difference between preoperative and postoperative urogenital and anorectal function in patients with positive IONM.…”

Section: Introductionmentioning

confidence: 99%

Optimising functional outcomes in rectal cancer surgery

Nocera¹,

Angehrn²,

Flüe³

et al. 2020

Langenbecks Arch Surg

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Background By improved surgical technique such as total mesorectal excision (TME), multimodal treatment and advances in imaging survival and an increased rate of sphincter preservation have been achieved in rectal cancer surgery. Minimal-invasive approaches such as laparoscopic, robotic and transanal-TME (ta-TME) enhance recovery after surgery. Nevertheless, disorders of bowel, anorectal and urogenital function are still common and need attention. Purpose This review aims at exploring the causes of dysfunction after anterior resection (AR) and the accordingly preventive strategies. Furthermore, the indication for low AR in the light of functional outcome is discussed. The last therapeutic strategies to deal with bowel, anorectal, and urogenital disorders are depicted. Conclusion Functional disorders after rectal cancer surgery are frequent and underestimated. More evidence is needed to define an indication for non-operative management or local excision as alternatives to AR. The decision for restorative resection should be made in consideration of the relevant risk factors for dysfunction. In the case of restoration, a side-to-end anastomosis should be the preferred anastomotic technique. Further high-evidence clinical studies are required to clarify the benefit of intraoperative neuromonitoring. While the function of ta-TME seems not to be superior to laparoscopy, case-control studies suggest the benefits of robotic TME mainly in terms of preservation of the urogenital function. Low AR syndrome is treated by stool regulation, pelvic floor therapy, and transanal irrigation. There is good evidence for sacral nerve modulation for incontinence after low AR.

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Fecal incontinence after total mesorectal excision for rectal cancer—impact of potential risk factors and pelvic intraoperative neuromonitoring

Cited by 21 publications

References 22 publications

A new method of intraoperative pelvic neuromonitoring: a preclinical feasibility study in a porcine model

A new method of intraoperative pelvic neuromonitoring: a preclinical feasibility study in a porcine model

Technique of neuromonitoring during pelvic peritonectomy

Optimising functional outcomes in rectal cancer surgery

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