Belisova, M.

Beltrán-Miranda, P.

Capitan-Morales, Luis-Cristobal

Galán-Álvarez, Juan

Guerrero-García, J. M.

Gómez Rosado, Juan Carlos

Valdés Hernández, Javier

idUS. Depósito de Investigación Universidad de Sevilla

proctography images. Joint mobility was assessed using the validated Beighton score. A score of 4 orgreater is significant for joint hypermobility.Results: Forty-eight female patients were included, the mean age was 58.4 years (range 22–78 years.)The mean Beighton score was 1.5 (range 0–6); nine patients had a score of 4 or greater. A Pearsoncorrelation coefficient did not demonstrate a positive correlation between perineal descent and jointmobility (-0.10, P value = 0.47.)Conclusion: This study does not show a greater degree of perineal descent in patients with mobilejoints. Multiple factors may contribute to the development of perineal descent; the pathophysiology ofthis finding remains unknown.P208Peripheral neuromodulation via posterior tibial nerve stimulation (ptns) astreatment for faecal incontinence – initial experienceJ.-C. Gomez-Rosado, J. Valdes-Hernandez, P. Beltran-Miranda, L.-C. Capitan-Morales, J.-M.Guerrero-Garcia, J. Galan-Alvarez & M. BelisovaHospital Universitario Virgen Macarena, Sevilla, SpainAim: Neuromodulation therapy via sacral nerve for faecal incontinence (FI) seems to be effective, butexpensive. Posterior tibial nerve could be a option, as it has been shown to be effective in stressurinary incontinence, but there is not enough evidence for its use in FI.Method: Fifteen women were treated with PTNS [average age 54.06; (35–75)]. Five patients hadprevious sphincter repair. All patients are evaluated previously with defecation diary, Wexner FIseverity score and faecal incontinence quality of life questionnaire (FIQL), endoluminal ultrasoundand anorectal manometry, as well as detailed anamnesis. PTNS was performed on a weekly basis for12 weeks with 30 min duration times, and after follow up evaluation, treatment continued every2 weeks on a further 12 occasions. During treatment, patients were requested to complete a dailydefecation diary.Results: After the first phase, improvement in continence was found in eight of 11 patients. Fourpatients are still in 1st phase. Two patients discontinued treatment because of an absence of response.Two patients have finished treatment with improvement of symptoms. FIQL scales were improvedglobally in each domain, except that of embarrassment. Wexner score changed from a mean 16.25 atbaseline to 7.2 after 24 sessions.Conclusion: PTNS results in improvement of FI with a minimally invasive modality. Larger trialsand long-term follow-up are needed.P209Anal acoustic reflectometry: a novel technique in the evaluation of malepatients with faecal leakageB. Hornung1, P. Mitchell1, N. Klarskov2, G. Lose2, G. Carlson3 & E. Kiff11University Hospital South Manchester, Manchester, UK, 2Herlev Hospital, Copenhagen, Denmark,3Salford Royal University Hospital, Manchester, UKAim: A particular subgroup of incontinent males, in whom the pathophysiology remains unclear, willcomplain of faecal leakage particularly after defaecation. Anal acoustic reflectometry (AAR) is a noveltechnique providing a dynamic physiological assessment of anal sphincter function, allowing thefollowing parameters to be determined: Opening Pressure, Opening Elastance, Closing Pressure,Closing Elastance, and Hysteresis. The aim was to compare assessment with AAR and conventionalmanometry in a group of male ‘leakers’ versus a group of continent males.Method: Male patients with faecal leakage (n = 13) were compared with an age-matched group ofcontinent males (n = 13). Subjects underwent assessment with AAR followed by manometry in theleft lateral position.Results: The acoustic parameters of Opening and Closing Pressure were significantly lower in thosepatients with faecal leakage compared with normal males (42.7 vs 64.6 cm H2O, P < 0.05 and 31.5 vs63.8 cm H2O, P < 0.01 respectively). No significant difference was seen with manometry.Conclusion: The results suggest that, in anal ‘leakers’ the ability of the anal sphincter to remainclosed against an increasing pressure and to return to its closed form following defaecation areimpaired, allowing seepage of stool. In contrast to manometry, AAR may be sensitive to discriminate‘leakers’ from continent males.P210Intraoperative neuromonitoring (IONM) in pelvic surgery – new scopes ofapplicationW. Kneist, D. W. Kauff, S. Huppert, B. Jansen-Winkeln & H. LangDepartment of General and Abdominal Surgery, University Medicine of the Johannes GutenbergUniversity, Mainz, GermanyAim: To open up potential scopes of application for a newly developed IONM method enablingsimultaneous assessment of bladder and internal anal sphincter (IAS) innervation.Method: Eight patients with different indications for pelvic surgery [one with low anterior resection(LAR) for rectal cancer, one with abdomino-perineal excision (APE) for ultra-low rectal tumour, twowith open and laparoscopic mesorectal dissection for presacral tumour excision, two with sacral nervestimulation (SNS) for anorectal and urinary dysfunction and two with laparoscopic resectionrectopexy (LRR) for rectal prolapse] underwent IONM with simultaneous observation of bladdermanometry and electromyography of IAS.Results: IONM confirmed intact innervation in patients undergoing LAR, laparoscopic mesorectaldissection and LAR. A continuous IONM was achieved in the patient undergoing LAR. The patientwho was scheduled for APE had positive IONM results after mesorectal dissection leading to thedecision to perform a sphincter-saving procedure. Follow up (FU) demonstrated good anorectal andurinary function. In patients treated with SNS, IONM enabled guidance and positioning of the SNSelectrodes near nerve fibers allowing simultaneous activation of external anal sphincter and IAS andbladder. FU demonstrated an improved functional outcome.Conclusion: The newly developed IONM method offers a variety of applications.P211Obstructed defecation and pelvic floor descent – internal Delorme procedure ina day surgery practiceP. KosorokIatros Medical Centre, Ljubljana, SloveniaAim: Obstructed defecation is serious problem in patients with constipation. The main problem isinternal rectal prolapse. Different techniques are used for correction. We performed Delorme andinternal Delorme procedure for total and internal rectal prolapse. Internal prolapse was confirmedclinically and by defecography. ASA criteria and principals of day surgery practice were observed.Method: Thirty female patients (age 40–88 years, average 68.6 years), with different stage of rectalprolapse, were treated in a day surgery unit under epidural anesthesia. Follow up was from 1 to24 months.Results: Postoperative stay was from 5 to 9 hours. We carefully followed the patients at home (pain,defecation, pain post defecation, blood on the stool, urinary function and other documentedcomplications). Pain was adequately treated with Nalgesin (NSAD) and paracetamol. Anal stenosiswas noted in fourteen cases and was treated with anal dilators (Dilatan - Sapimed) or operatively withincision or dilatation under anaesthesia.Conclusion: Delorme and internal Delorme - intraanal mucosectomy, is a safe and effective surgicaltreatment for complete or internal rectal prolapse. The procedure may be safely performed in a daysurgery unit, on patients with reasonable medical comorbidities and in relatively old age.P212Sacral nerve stimulation for refractory constipation: a useful optionJ. Leite, A. Manso, S. Martins, A. Monteiro, M. Serodio & F. Castro-SousaCoimbra University Hospital, Coimbra, PortugalAim: Election of the best treatment for severe constipation is difficult. The aim of this study was toevaluate our experience with sacral nerve stimulation (SNS) on refractory constipation.Method: Patients who failed conservative treatment underwent 3 weeks test stimulation. All hadincreased colonic transit time with absence of anorectal dyssynergism on defecography. Patients with> 50% improvements in symptoms underwent permanent neurostimulator implantation.Results: Nine females (median age 37 years) underwent test stimulation, of whom 6 (67%)proceeded to permanent stimulation. After a median 23 (range 4–30) months follow-up the Clevelandconstipation score decreased from 19 to 9 (P < 0.05). After the first 3–6 months, loss of efficacy wasnoted in four patients. These adverse events were resolved by reprogramming the device in twopatients.Conclusion: SNS has acceptable efficacy (4/9, 44%) and seems to be a useful option in the treatmentof refractory constipation.P213Surgical treatment of adult Hirschsprung and idiopathic megacolon/megarectumJ. Leite, A. Manso, S. Martins, A. Monteiro, C. Carvalho & F. Castro-SousaCoimbra University Hospital, Coimbra, PortugalAim: Surgical treatment of refractory constipation is unsatisfactory. However a surgical option isnecessary in adult Hirschsprung or in idiopatic megacolon of long-standing severe constipation andthe aim of this study was to evaluate the surgical outcome for these cases.Method: Between 1990 and 2010, 3 adult Hirschsprung (median age 22 years) were treated byrestorative proctocolectomy (2) and rectosigmoid excision with coloanal anastomosis (CA, 1) and 11idiopathic megacolon/megarectum (median age 47 years) treated by total colectomy (10) and CA (1).The outcome of last clinic was recorded as good, fair or unfair and was evaluated the Clevelandconstipation score before and after the procedure.Results: With a median follow-up of 71 months, 9 (64%) patients had good outcome and 5 (36%)fair, due to intermittent symptoms of sub-obstruction, pain, obstructive defecation and incontinence.The median Cleveland constipation score decreased from 20 to 5 (P < 0.01).Conclusion: Surgery is the appropriate approach for adult Hirschsprung and idiopathic megacolon/megarectum for long-standing severe constipation.P214Peristeen anal irrigation in the management of faecal incontinenceS. Miller & D. ArtioukhSouthport & Ormskirk Hospital, Southport, Merseyside, UKAim: Peristeen anal irrigation is an innovative management of faecal incontinence by washout of thedistal large bowel with warm tap water using a rectal catheter. The aim of the study was to evaluatethe effectiveness of the technique both in terms of the symptomatic control and assessment of thequality of life.Method: The study included 17 consecutive patients (seven men, 10 women; median age 51 years,range 5–72 years) suffering with faecal incontinence of various aetiology. All patients were unable tocontrol the symptom conservatively by pads, anal plugs and constipating agents and were not preparedto accept invasive surgical treatment. The outcome was assessed symptomatically and by comparingscores of faecal incontinence and quality of life before and after the treatment.Results: Peristeen anal irrigation helped to achieve control of faecal incontinence in 13 (76%)patients. In the remaining 4 (24%) patient improvement was regarded as partial due occasionaltechnical failure of administration (burst balloon) or patients’ subjective incomplete satisfaction.Comparison of scores of faecal incontinence and the quality of life showed significant improvement.Conclusion: Peristeen anal irrigation is a safe and successful method of management of faecalincontinence in well-motivated patients.P215Long-term results of anal function after intersphincteric resection for low rectalcancerT. Ohgara, N. Saito, M. Sugito, M. Ito, A. Kobayashi & Y. NishizawaNational Cancer Center Hospital East, Kasiwa, Chiba, JapanAim: Recently, Intersphincteric resection (ISR) has been widely recognized as an innovative surgery.However, there are few reports regarding long term results of anal function after ISR. The aim of thisstudy was to assess the long-term functional outcomes following ISR.Method: A functional questionnaire was sent to alive patients and without recurrence whounderwent curative ISR between February 2000 and March 2006. Those answers were evaluatedusing the Facal Incontinence Severity Index [Wexner’s Score (WS)] at 2 and over 5 years afteroperation were investigated. These were also assessed according to operation types (partial, subtotal,total), and with or without preoperative chemoradiation (CRT).Results: Among 52 available patients, 42 patients responsed to the questionnaire. Mean WS was 9.0at 2 years postoperatively, and 7.0 at over 5 years (P < 0.05). There were no significant differences inWS of each types of operation. There were significant differences in WS between patients with CRTPostersÓ 2011 The Authors54 Colorectal Disease Ó 2011 The Association of Coloproctology of Great Britain and Ireland. 13 (Suppl. 6), 28–62

Peripheral neuromodulation via posterior tibial nerve stimulation (ptns) as treatment for faecal incontinence – initial experience

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Peripheral neuromodulation via posterior tibial nerve stimulation (ptns) as treatment for faecal incontinence – initial experience

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