Treatment fecal incontinence in children with bulking agents «DAM+»

Abstract

One of the reason of organic and neurogenic fecal incontinence in children is low resting pressure in the anal canal. In functional aspect, one of the main roles plays internal sphincter of the anal canal that provides 50-85 % of basal resting pressure and close of the anal canal. Purposes. The purpose of this article is to study the possibilities of using bulking agent «DAM+» to increase resting pressure in the anal canal in children with fecal incontinence, and evaluate the results of this treatment. Metods. The study has been performed in the Department of Pediatric Surgery in our university since 2007 for 2013. In total, 35 patients, aged 2-18 with organic or neurogenic fecal incontinence were underwent 57 procedure of introduction polyacrylamid gel «DAM+». Patients with overflow fecal incontinence were excluded. Before treatment and after, all patients were assessed clinical examination and anal manometry. Anal manometry was perfomed оn multifunctional apparatus «Menfis 2000». Results. The average quantity of resting pressure in the anal canal before operation is formed 20.98 ± 5.17 сm. (H2O), after operation 32.62 ± 6.63 сm. (H2O), in long-term period 28.07 ± 6.65 сm. (H2O) Conclusion. The clinical efficiency of procedure correlates with values of resting pressure in the anal canal before and after treatment. Implantation of «DAM+» into submucosal layer provides increasing of basal resting tone in the anal canal. Imitation of work of the internal anal sphincter and expansive vascular anal cushions on the other part, prevents patulous anus and provides a hermetic seal, that responds for close anal walls. Statistical data was shown, that the average quantity of resting pressure in the anal canal before operation and after operation has performed at the 5 % significance level. P-values < 0.05 was considered statistically significant.