- 99 patients with FI (Fecal Incontinence) with or without OD (Obstructed Defecation)
- Gender: 68 females, 21 males
- Age: 36 – 64; mean 47.2
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Management of Fecal Incontinence
at Mediclinic Dubai Mall 2021-2025 – CASE Series
Dr. Katalin Kalmar
MD, PhD, EBSQcoloproctology
Patients
Investigations - basic
Investigations - subspeciality
- Anorectal manometry and rectal sensitivity testing
- Endo-anal Ultrasound Scan
- MRI Proctography
Scores
Investigation Algorythm
Treatment options
Conservative
Operative
- Dietary changes, fiber
- Toilet habits, posture
- Pelvic Floor Physiotherapy
- Bio-feedback
- PTNS
FI
- Sphincteroplasty
- Anal Sphincter Augmentation – Sphinkeeper
- SNS
FI & OD
- Sphincteroplasty & Rectocele Repair
Treatment Algorythm
Surgeries
Of these 99 patient 19 had surgeries – 6 for both OD and FI; 5 for only FI and 3 for only OD
- 2 pt had only Sphincteroplasty
- 7 patients had Rectocele Repair and Sphincteroplasty
- 4 patients had only Sphin-keeper implants
- 3 patients had Sphincteroplasty and Sphin-keeper implants – two of them at least 6 months apart and one of them in one session
- 2 patients had STARR
- 1 patient had complex perineal repair for Cloaca –
Reconstruction of sphincter, anal and vaginal introitus wall, perineal body, Martius flap and rotational local skin flap
Surgeries
Sphincteroplasty
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these photos contain sensitive content which some people may find offensive and disturbing
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these photos contain sensitive content which some people may find offensive and disturbing
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these photos contain sensitive content which some people may find offensive and disturbing
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these photos contain sensitive content which some people may find offensive and disturbing
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these photos contain sensitive content which some people may find offensive and disturbing
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these photos contain sensitive content which some people may find offensive and disturbing
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these photos contain sensitive content which some people may find offensive and disturbing
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these photos contain sensitive content which some people may find offensive and disturbing
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these photos contain sensitive content which some people may find offensive and disturbing
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these photos contain sensitive content which some people may find offensive and disturbing
Sphinctero-plasty and Sphin-keeper together
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these photos contain sensitive content which some people may find offensive and disturbing
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these photos contain sensitive content which some people may find offensive and disturbing
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these photos contain sensitive content which some people may find offensive and disturbing
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these photos contain sensitive content which some people may find offensive and disturbing
Repair of “Cloaca”
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these photos contain sensitive content which some people may find offensive and disturbing
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these photos contain sensitive content which some people may find offensive and disturbing
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these photos contain sensitive content which some people may find offensive and disturbing
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these photos contain sensitive content which some people may find offensive and disturbing
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these photos contain sensitive content which some people may find offensive and disturbing
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these photos contain sensitive content which some people may find offensive and disturbing
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these photos contain sensitive content which some people may find offensive and disturbing
Sphinctero-plasty
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these photos contain sensitive content which some people may find offensive and disturbing
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these photos contain sensitive content which some people may find offensive and disturbing
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these photos contain sensitive content which some people may find offensive and disturbing
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these photos contain sensitive content which some people may find offensive and disturbing
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these photos contain sensitive content which some people may find offensive and disturbing
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these photos contain sensitive content which some people may find offensive and disturbing
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these photos contain sensitive content which some people may find offensive and disturbing
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these photos contain sensitive content which some people may find offensive and disturbing
Sensitive content
these photos contain sensitive content which some people may find offensive and disturbing
Sensitive content
these photos contain sensitive content which some people may find offensive and disturbing
Sensitive content
these photos contain sensitive content which some people may find offensive and disturbing
Sphinctero-plasty and Sphin-keeper together
Sensitive content
these photos contain sensitive content which some people may find offensive and disturbing
Sensitive content
these photos contain sensitive content which some people may find offensive and disturbing
Sensitive content
these photos contain sensitive content which some people may find offensive and disturbing
Sensitive content
these photos contain sensitive content which some people may find offensive and disturbing
Repair of “Cloaca”
Sensitive content
these photos contain sensitive content which some people may find offensive and disturbing
Sensitive content
these photos contain sensitive content which some people may find offensive and disturbing
Sensitive content
these photos contain sensitive content which some people may find offensive and disturbing
Sensitive content
these photos contain sensitive content which some people may find offensive and disturbing
Sensitive content
these photos contain sensitive content which some people may find offensive and disturbing
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these photos contain sensitive content which some people may find offensive and disturbing
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these photos contain sensitive content which some people may find offensive and disturbing
Sphinctero-plasty and Sphin-keeper implants in separate settings
Results
- Age:
- Female : Male
- Preoperative Wexner Score:
- Preoperative St Mark’s Score:
- Postoperative Wexner Score:
- Postoperative St Mark’s Score:
- Patient Satisfaction (Happiness Score 0-10):
47.5 (35-64) years
16:1
10.5/20 points
13.9/24 points
5.66/20 points
5.61/24 points
7.1 points
Conclusion
- Fecal Incontinence requires a subspeciality approach (Proctologist should do it)
- Many patients sufficiently benefit from conservative treatment. For them no need to proceed with surgery
- Surgical Inteventions for fecal Incontinence on well selected patients result in significant functional improvement
- Sphin-keeper implantation is a simple, low risk procedure, providing limited benefits, which might be just enough for patients, particularly with passive (IAS type) incontinence
- Anal Sphincteroplasy is fixing EAS defect only. This procedure requires detailed knowledge of the anatomy and has a long learning curve. Considerable morbidity (longer healing, restrictions in the postoperative period) needs to be weighed against diminishing benefits (achievable improvement in Fecal Incontinence for the long term)
References
- 1.The Clinical Utility of Anorectal manometry. A Review of Current Practices. Belilos EA, Post Z, Anderson S, deMeo M, Gastro Hep advances Volume 10; 4(2) Oct 2024
- 2.Endoanal and Endorectal Ultrasound: Applications in Colorectal Surgery. Riegert N et al; ANZ J Surg 2004; 74(8): 671-675.
- 3.Etiology and management of fecal incontinence. Jorge JMN and Wexner SD; Diseases of the Colon and Rectum Volume 36: 77-97.
- 4.Prospective Comparison of Fecal Incontinence Grading Systems. Vaizey CJ, Carapeti E, Cahill JA, Kamm MA; Gut Volume 44: 77-80.
- 5.Clinical Assesment, Conservative Management, Specialized Diagnostic Testing and Qualty of Life for Fecal Incontinence: Update on Research and Practice recommendations. Bliss DZ, Mimura T, Berghmans B, Bharucha AE, Carrington EV, Engberg SJ, Hunter K, Santoro GA, Kumaran T, Sakakibara R, Emmanuel A, Panicker J. Continence Volume 9, March 2024 101063
- 6.Short- and Long-term Outcomes of Sphincteroplasty for Anal Incontinence related to Obstetric Injury: a Systematic Review. Mongardini FM et al. Updates Surg 2023 Sept; 75(6):1423-1430.
Special thanks to my teachers
Angus McDonald
Lanarkshire NHS Trust, Scotland
Carolynne Vaizey
St Mark’s Hospital and Academic Institute, London UK
Robin Phillips
St Mark’s Hospital and Academic Institute, London UK
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