Long-Term Results of Repeat Anterior Anal Sphincter Repair

Vaizey, C. J.; Norton, Christine; Thornton, Michelle; Nicholls, R. J.; Kamm, Michael A.

doi:10.1007/s10350-003-0112-8

Cited by 86 publications

(40 citation statements)

References 22 publications

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“…In severely symptomatic patients, the options are to replace the external anal sphincter with autologous tissue such as graciloplasty or implantation of an artificial anal sphincter. However, none of these options is efficacious in the long term or without complications related to the surgery or the device [21][22][23][24][25].…”

Section: Introductionmentioning

confidence: 99%

Functional Outcome After Anal Sphincter Injury and Treatment With Mesenchymal Stem Cells

Salcedo

Penn

Damaser

et al. 2014

Stem Cells Translational Medicine

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This research demonstrates the regenerative effects of mesenchymal stem cells (MSCs) on the injured anal sphincter by comparing anal sphincter pressures following intramuscular and serial intravascular MSC infusion in a rat model of anal sphincter injury. Fifty rats were divided into injury (n = 35) and no injury (NI; n = 15) groups. Each group was further divided into i.m., serial i.v., or no-treatment (n = 5) groups and followed for 5 weeks. The injury consisted of an excision of 25% of the anal sphincter complex. Twenty-four hours after injury, 5 3 10 5 green fluorescent protein-labeled MSCs in 0.2 ml of phosphate-buffered saline (PBS) or PBS alone (sham) were injected into the anal sphincter for i.m. treatment; i.v. and sham i.v. treatments were delivered daily for 6 consecutive days via the tail vein. Anal pressures were recorded before injury and 10 days and 5 weeks after treatment. Ten days after i.m. MSC treatment, resting and peak pressures were significantly increased compared with those in sham i.m. treatment (p < .001). When compared with the NI group, the injury groups had anal pressures that were not significantly different 5 weeks after i.m./i.v. treatment. Both resting and peak pressures were also significantly increased after i.m./i.v. MSC treatment compared with treatment with PBS (p < .001), suggesting recovery. Statistical analysis was done using paired t test with Bonferroni correction. Marked decrease in fibrosis and scar tissue was seen in both MSC-treated groups. Both i.m. and i.v. MSC treatment after injury caused an increase in anal pressures sustained at 5 weeks, although fewer cells were injected i.m. The MSC-treated groups showed less scarring than the PBS-treated groups, with the i.v. infusion group showing the least scarring. STEM CELLS TRANSLATIONAL MEDICINE 2014;3:760-767

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Section: Introductionmentioning

confidence: 99%

Functional Outcome After Anal Sphincter Injury and Treatment With Mesenchymal Stem Cells

Salcedo

Penn

Damaser

et al. 2014

Stem Cells Translational Medicine

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“…Even more importantly, there is a reported rapid decay in function after repair that is too great to be explained by age alone. [30][31][32][33][34][35][36][37] Third, if direct trauma to the anal sphincter (and not intrapelvic nerves) were the major cause of anal incontinence, then C-section should be effective in preventing incontinence. This review has shown that this is not the case.…”

Section: Discussionmentioning

confidence: 98%

A Systematic Review of the Efficacy of Cesarean Section in the Preservation of Anal Continence

Nelson

Westercamp

Furner

2006

Diseases of the Colon &Amp; Rectum

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PURPOSE: Elective primary cesarean section is performed largely to avoid maternal pelvic trauma that may result in anal incontinence, although its efficacy in this regard has not been thoroughly assessed. We perform a systematic review of published reports that compare anal incontinence risk by mode of delivery. METHODS: PubMed was searched from 1966 through August 2005. Authors were contacted for missing data or analyses. Both randomized and nonrandomized reports were included. Eligible studies included females having vaginal delivery or cesarean section, fecal and/or flatal incontinence was reported as an outcome, and risk was calculable from the reported data. Crude data were extracted from the reports, as well as reported odds ratios and confidence intervals. In the nonrandomized studies, adjusted odds ratios also were extracted and additional data obtained from authors to adjust risks for age and parity if not originally done. Sensitivity analyses were performed using quality indicators: age and parity adjustment, time to continence assessment, and mode of previous delivery. RESULTS: Fifteen studies were found eligible, encompassing 3,010 cesarean sections and 11,440 vaginal deliveries. The summary relative risk for fecal incontinence was 0.91 (95 percent confidence interval, 0.74-1.14). For flatus the relative risk was 0.98 (range, 0.86-1.13). The number needed to treat by cesarean section was 167 to prevent a single case of fecal incontinence. Five studies were judged to be of high quality. In these studies, the summary relative risk was 0.94 (range, 0.72-1.22) and number needed to treat was 198. CONCLUSIONS: The best evidence to assess the efficacy of cesarean section in the prevention of anal incontinence would be in randomized trials of averagerisk pregnancies with few crossovers. In the absence of such trials and based on this review, cesarean section does not prevent anal incontinence. This implies that incontinence associated with delivery may be more likely incontinence caused by pregnancy. [

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“…Surgery remains the last resort for refractory FI. The long term results after sphincter repair are modest [12][13][14] . In patients with internal rectal prolapse, anterior rectopexy may be promising as an alternative surgical approach [15] .…”

Section: Discussionmentioning

confidence: 99%

Endoscopic and imaging appearance after injection of an ano-rectal bulking agent

Papafragkakis¹

2014

WJGE

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The use of hyaluronic acid and dextranomer (Solesta, Salix) injection in the anal canal is an emerging modality in the treatment of fecal incontinence. However, little is known regarding the endoscopic and radiological appearance following injection of this ano-rectal bulking agent. We report computed tomography and endoscopic findings after hyaluronic acid/dextranomer injection in the ano-rectal area.© 2014 Baishideng Publishing Group Inc. All rights reserved.Key words: Fecal incontinence; Ano-rectal bulking agent; Hyaluronic acid; Dextranomer Core tip: The use of hyaluronic acid and dextranomer (Solesta, Salix) injection in the ano-rectum is an emerging modality in the treatment of fecal incontinence. Our case discusses the endoscopic and radiological findings after injection of this bulking agent in the ano-rectal area.Papafragkakis H, Changela K, Bhatia T, Ona MA, Malieckal A, Paleti V, Fuksbrumer MS, Anand S. Endoscopic and imaging appearance after injection of an ano-rectal bulking agent. World J Gastrointest Endosc 2014; 6(7): 324-327 Available from: URL:

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Long-Term Results of Repeat Anterior Anal Sphincter Repair

Abstract: Repeat anterior sphincter repair results in improved continence for the majority of patients, with no substantial change between the short-term and long-term follow-up.

Cited by 86 publications

References 22 publications

Functional Outcome After Anal Sphincter Injury and Treatment With Mesenchymal Stem Cells

Functional Outcome After Anal Sphincter Injury and Treatment With Mesenchymal Stem Cells

A Systematic Review of the Efficacy of Cesarean Section in the Preservation of Anal Continence

Endoscopic and imaging appearance after injection of an ano-rectal bulking agent

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