PURPOSE: This study was designed to compare two different types of anal retractors (Parks vs. Scott) with regard to their impact on fecal continence after fistula repair. METHODS: Between November 2000 and November 2001, 30 patients were randomized into two groups. In Group A (n = 15), a Parks retractor was used during fistula repair, whereas in Group B (n = 15), the repair was performed with a Scott retractor. Before and three months after surgery, maximum anal resting pressure and maximum anal squeeze pressure were recorded. In addition, continence status was evaluated using both the Rockwood Fecal Incontinence Severity Index and the scoring system according to Parks. RESULTS: In Group A, the median anal resting pressure dropped from 76 mmHg to 42 mmHg. In Group B, no significant difference was observed between the preoperative and postoperative anal resting pressure. The difference in the changes from baseline between the two groups was statistically significant (P = 0.035). No significant changes in anal squeeze pressure were observed. In Group A, the median Rockwood fecal incontinence score increased from 0 to 12. In Group B, the median Rockwood fecal incontinence score did not change after the operation. The difference between the two groups was statistically significant (P = 0.038). CONCLUSIONS: The use of a Parks retractor during perianal fistula repair has a deteriorating effect on fecal continence, probably because of damage to the internal anal sphincter. Because this side effect was not observed after the use of a Scott retractor, we advocate the use of this retractor during all fistula repairs.
To evaluate the therapeutic effect of sacral neuromodulation on faecal incontinence in patients with structurally intact sphincters.Prospective.In the period April 1st, 2000 to November 30th, 2001, patients with faecal incontinence and structurally intact sphincters were included, with or without previous surgery, in whom medicinal treatment and biofeedback therapy gave no improvement. Incontinence was defined as involuntary loss of stool at least once a week, which was objectified by completion of a 3-week bowel habit diary. Patients underwent 3 weeks of trial stimulation during which they also kept a diary. The trial stimulation was considered successful if the diary showed a > or = 50% improvement in continence.38 patients (31 women) with an average age of 54 years (range: 26-73) underwent trial stimulation. Trail stimulation was carried out using a permanent electrode in 6 patients and using peripheral neural evaluation in the remaining 32 patients. Two patients did not respond to peripheral neural evaluation. Upon assessment after the trial stimulation period. continence was found to have improved by > or = 50% in 31 (82%) patients. The number of incontinence episodes decreased by an average of 86% (range: 50-100). In 27 patients an implantable pulse generator was implanted for continuous stimulation. During the average follow-up of 6 months the effect remained satisfactory. Anal manometry during stimulation showed no increase of sphincter pressures.Sacral neuromodulation was of therapeutic value in most of the patients treated for faecal incontinence without sphincter damage.
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