Incontinence after fistulotomy in low anal fistula: Can Kegel exercises help improve postoperative incontinence?

被引:0
作者
Garg, Pankaj [1 ,2 ]
Sohal, Aalam [3 ]
Yagnik, Vipul D. [4 ]
Kaur, Baljit [5 ]
Menon, Geetha R. [6 ]
Dawka, Sushil [7 ]
机构
[1] Ind Hosp, SCF 98-100,Near Chawla Chowk,Phase 3B-2,Sect 60, Mohali 160059, Punjab, India
[2] Univ Calif San Francisco UCSF, Fresno, CA USA
[3] Garg Fistula Res Inst, Panchkula, India
[4] Nishtha Surg Hosp & Res Ctr, Patan, Gujarat, India
[5] SSRD Imaging Ctr, Chandigarh, India
[6] Indian Council Med Res, New Delhi, India
[7] SSR Med Coll, Belle Rive, Mauritius
关键词
anal fistula; fistulotomy; incontinence; Kegel exercises; manometry; urge; FECAL INCONTINENCE; IN-ANO; PATIENT; CLASSIFICATIONS; MANAGEMENT; CONTINENCE; COHORT;
D O I
10.5604/01.3001.0015.9820
中图分类号
R61 [外科手术学];
学科分类号
摘要
Aim: Fistulotomy is the commonest procedure performed for low anal fistulas. The incidence of gas and urge incontinence after fistulotomy and whether Kegel exercises (KE) could help recover sphincter function after fistulotomy has not been studied before. Methods: Patients operated with fistulotomy for low fistulas were recommended KE (pelvic contraction exercises) 50 times/day for one year postoperatively. Incontinence (solid, liquid, gas, and urge) was evaluated objectively (Vaizey's scores) preoperatively [Pre-op Group], in the immediate postoperative period [Pre-KE Group], and at 6-month follow-up [Post-KE Group]. Incontinence scores in all three groups were compared to evaluate the efficacy of KE. Results: As many as 101 MRI-documented low anal fistula patients were included. There were 79 males (mean age 39.4 +/- 12.9 years) and the median follow-up was 12 months (6-18 months). Two patients were lost to follow-up. Fistulas healed in all the patients. Incontinence was present in 5/99 patients (mean incontinence scores -0.13 +/- 0.63) preoperatively and occurred in 20/99 (mean incontinence scores -1.03 +/- 2.18) patients postoperatively (Pre-KE Group). With KE, the incontinence improved completely in 10 and partially in another 10 (mean incontinence scores -0.31 +/- 1.09) patients. Urge and gas incontinence accounted for most cases (80%). The mean incontinence scores deteriorated significantly after fistulotomy (pre-op vs pre-KE, p = 0.000059, significant) but continence improved significantly with KE, thus the scores between pre-op and post-KE became comparable (pre-op vs post-KE, p = 0.07, not significant). Conclusions: Fistulotomy, even in low fistulas, can lead to a significant increase in gas and urge incontinence. Regular Kegel exercises postoperatively can help recover lost sphincter function and can bring back continence comparable to preoperative levels.
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页码:13 / 19
页数:7
相关论文
共 24 条
[1]   The outcome of fistulotomy for anal fistula at 1year: a prospective multicentre French study [J].
Abramowitz, L. ;
Soudan, D. ;
Souffran, M. ;
Bouchard, D. ;
Castinel, A. ;
Suduca, J. M. ;
Staumont, G. ;
Devulder, F. ;
Pigot, F. ;
Ganansia, R. ;
Varastet, M. .
COLORECTAL DISEASE, 2016, 18 (03) :279-285
[2]   The STROCSS statement: Strengthening the Reporting of Cohort Studies in Surgery [J].
Agha, Riaz Ahmed ;
Borrelli, Mimi R. ;
Vella-Baldacchino, Martinique ;
Thavayogan, Rachel ;
Orgill, Dennis P. .
INTERNATIONAL JOURNAL OF SURGERY, 2017, 46 :198-202
[3]   Management of cryptoglandular fistula-in-ano among gastrointestinal surgeons in the Netherlands [J].
Dekker, L. ;
Zimmerman, D. D. E. ;
Smeenk, R. M. ;
Schouten, R. ;
Han-Geurts, I. J. M. .
TECHNIQUES IN COLOPROCTOLOGY, 2021, 25 (06) :709-719
[4]   Long-term continence disturbance after lateral internal sphincterotomy for chronic anal fissure: a systematic review and meta-analysis [J].
Garg, P. ;
Garg, M. ;
Menon, G. R. .
COLORECTAL DISEASE, 2013, 15 (03) :E104-E117
[5]   Including video and novel parameter-height of penetration of external anal sphincter-in magnetic resonance imaging reporting of anal fistula [J].
Garg, Pankaj ;
Kaur, Baljit ;
Yagnik, Vipul D. ;
Dawka, Sushil .
WORLD JOURNAL OF GASTROINTESTINAL SURGERY, 2022, 14 (04) :271-275
[6]   Assessing validity of existing fistula-in-ano classifications in a cohort of 848 operated and MRI-assessed anal fistula patients - Cohort study [J].
Garg, Pankaj .
ANNALS OF MEDICINE AND SURGERY, 2020, 59 :122-126
[7]   Keyhole deformity - routinely heard, commonly feared but perhaps never seen! [J].
Garg, Pankaj .
ACTA CHIRURGICA BELGICA, 2020, 120 (05) :361-362
[8]   Is fistulotomy still the gold standard in present era and is it highly underutilized?: An audit of 675 operated cases [J].
Garg, Pankaj .
INTERNATIONAL JOURNAL OF SURGERY, 2018, 56 :26-30
[9]   Comparing existing classifications of fistula-in-ano in 440 operated patients: Is it time for a new classification? A Retrospective Cohort Study [J].
Garg, Pankaj .
INTERNATIONAL JOURNAL OF SURGERY, 2017, 42 :34-40
[10]   A Multicenter Randomized Controlled Trial Comparing Safety, Efficacy, and Cost-effectiveness of the Surgisis Anal Fistula Plug Versus Surgeon's Preference for Transsphincteric Fistula-in-Ano The FIAT Trial [J].
Jayne, David G. ;
Scholefield, John ;
Tolan, Damian ;
Gray, Richard ;
Senapati, Asha ;
Hulme, Claire T. ;
Sutton, Andrew J. ;
Handley, Kelly ;
Hewitt, Catherine A. ;
Kaur, Manjinder ;
Magill, Laura .
ANNALS OF SURGERY, 2021, 273 (03) :433-441