BACKGROUND: Incontinence is not rare after rectal cancer surgery. Platelet-rich plasma may promote tissue repair and generation but has never been tested for the treatment of anal incontinence. This study evaluated the impact of platelet-rich plasma injection on the severity of incontinence and quality of life after low rectal cancer surgery.
METHODS: This is a prospective cohort proof of concept study in a colorectal cancer institution. Patients had undergone low anterior or intersphincteric resection for low rectal cancer and had a Wexner score > 4. Ten milliliters of platelet-rich plasma were injected into the internal and external sphincters under endoanal ultrasound (EAUS) guidance. Primary outcome measure was > 2 point improvement in Wexner score (improved group). The patients were assessed with endo-anal ultrasound examination, manometry, the Wexner Questionnaire and SF-36 Health Surveys, and patients were asked whether they used pads and antidiarrheal medications before and 6 months after PRP injection.
RESULTS: Of 20 patients included in the study, 14 (70%) were men, and the average age was 56.8 (SD = 9.5) years. No statistically significant difference was found in Wexner scores before and after PRP injection (p = 0.66). Seven (35%) patients experienced a > 2 point improvement in Wexner score. Rectal manometry demonstrated improved squeezing pressure (p = 0.0096). Furthermore, physical functioning scoring (p = 0.023), role limitation (p = 0.016), emotional well-being (p = 0.0057) and social functioning (p = 0.043) domains on the SF-36 questionnaire improved. One (5%) and three (15%) patients stopped using pads and antidiarrheal medications.
CONCLUSIONS: Platelet-rich plasma injection does not restore Wexner scores, but more than one-third of patients may benefit from this application with an improvement of > 2 points in their scores. Platelet-rich plasma injection may improve squeezing pressure and certain life quality measures for incontinent patients after rectal cancer surgery.

Rectal prolapse is characterized by a full-thickness intussusception of the rectal wall and is associated with a spectrum of coexisting anatomic abnormalities. We developed the transabdominal levatorplasty technique for laparoscopic rectopexy, inspired by Altemeier\'s procedure. In this method, following posterior mesorectum dissection, we expose the levator ani muscle just behind the anorectal junction. Horizontal sutures, using nonabsorbable material, are applied to close levator diastasis associated with rectal prolapse. The aim of the transabdominal levatorplasty is to (i) reinforce the pelvic floor, (ii) narrow the anorectal hiatus, and (iii) reconstruct the anorectal angle. We report a novel transabdominal levatorplasty technique during laparoscopic rectopexy for rectal prolapse. The laparoscopic mesh rectopexy with levatorplasty technique was performed in eight cases: six underwent unilateral Orr-Loygue procedure, one modified Wells procedure, and one unilateral Orr-Loygue procedure combined with sacrocolpopexy for uterine prolapse. The median follow-up period was 178 (33-368) days, with no observed recurrences. Six out of seven patients with fecal incontinence experienced symptomatic improvement. Although the sample size is small and the follow-up period is short, this technique has the potential to reduce the recurrence rate and improve functional outcomes, as with levatorplasty of Altemeier\'s procedure. We believe that this technique may have the potential to become an option for rectal prolapse surgery.

UNASSIGNED: This study compared disease burden, experiences, and health-related quality of life (HRQoL) between patients with Crohn\'s perianal fistulas (CPFs) and those with Crohn\'s disease (CD) without perianal fistulas (PFs; non-PF CD).
UNASSIGNED: This cross-sectional, observational study was conducted in 3 cohorts of US patients aged 18-89 years with self-reported, physician-diagnosed CD: (1) non-PF CD; (2) CPF without PF-related surgery; and (3) CPF with PF-related surgery. Data on medical and surgical interventions, CD-specific symptoms, HRQoL (assessed using the Short Inflammatory Bowel Disease and 5-dimension EuroQol questionnaires), and fecal incontinence (assessed using Revised Faecal Incontinence Scale and Fecal Incontinence Quality of Life questionnaires) were collected via a web-enabled questionnaire.
UNASSIGNED: In total, 403 patients with CD completed the questionnaire (non-PF CD, n = 300; CPF without surgery, n = 51; CPF with surgery, n = 52). A high symptom burden was seen across cohorts. More patients with CPF underwent ≥1 CD-related surgery and experienced ≥1 failure of CD-related surgery (79% and 20%) vs non-PF CD (53% and 9%; P < .001). Overall HRQoL outcomes were worse for patients with CPF vs non-PF CD, with significantly worse Short Inflammatory Bowel Disease and 5-dimension EuroQol questionnaire scores for those without PF-related surgery (P < .01). Across all cohorts, 58% of patients reported experiencing fecal incontinence, which had a greater negative impact (higher Revised Faecal Incontinence Scale scores; lower Fecal Incontinence Quality of Life scores) in patients with CPF vs non-PF CD.
UNASSIGNED: Patients with CPF experience substantial HRQoL burden, reflecting the impact of symptoms and medical/surgical interventions. These results may help to inform comprehensive care strategies to improve patient HRQoL.

UNASSIGNED: This study aimed to determine the efficacy and safety of autologous PRP in anal fistula.
UNASSIGNED: The search was done in electronic databases such as; PubMed, Scopus, Google Scholar, Embase, and Cochrane Library. The outcomes investigated in this study were the rate of improvement, the rate of recurrence, and the rate of fecal incontinence.
UNASSIGNED: Cure, incontinence, and recurrence rates were 68% (95% CI, .60-.76), 27% (95% CI, .12-.46), and 18% (95% CI, .12-.26), respectively. The pooled improvement ratio in patients treated with PRP compared to control group was 1.35 times, which was statistically significant (pooled OR=1.35, 95% CI, 1.14-1.60, P<001). The pooled recurrence ratio in patients treated with PRP compared to control group was 1.17, which was not statistically significant (pooled OR=1.17, 95% CI, 0.44-3.11).
UNASSIGNED: Platelet-rich plasma is an effective method of healing people with anal fistula.

暂无摘要。

UNASSIGNED: To compare patients\' self-administered responses to the Fecal Incontinence Severity Index (FISI) questionnaire (A1) with their responses to physician\'s oral interview (A3).
UNASSIGNED: Patients (n=100: mean age: 72 years; 66 women) with FI completed the FISI and the modified FISI (with written explanations) questionnaires, followed by a physician interview. To identify a threshold for the rating gap between A1 and A3, we calculated each patient\'s mean difference in the FISI scores.
UNASSIGNED: There was no significant difference in the FISI scores between A1 and A3. A rating gap existed in the FISI scores (mean difference=8.9). It occurred in 37% of the patients, making its threshold 9. Multivariate analysis revealed that older age and no history of pelvic floor surgery were independently associated with the presence of a rating gap in the FISI scores. The in-coincidence of ticked boxes to all types of leakage between the self-administered responses and those by physician\'s oral history was 49% (197/400). Older age was associated with the in-coincidence of a ticked box between the assessment results of gas or solid stool leakage.
UNASSIGNED: Some non-negligible discrepancy existed between patients\' self-administered responses and their responses to physician\'s oral interview, especially in older patients.

BACKGROUND: Fistula-tract laser closure (FiLaC™) has shown promising outcomes in perianal fistulizing Crohn\'s disease (pfCD). However, most studies assessed a mixed cohort encompassing pfCD and cryptoglandular fistulas during a short follow-up period. This study aimed to evaluate the long-term treatment outcomes of FiLaC™ in patients with complex pfCD.
METHODS: Data from patients with complex pfCD who underwent FiLaC™ during deep remission of Crohn\'s disease between January 2019 and December 2020 were retrospectively analyzed. Patient demographics, surgery history, and medication strategy were registered before surgery. Follow-ups were scheduled at 1, 2, and 3 months after FiLaC™, and at 2-month intervals thereafter. The primary endpoint was clinic healing, while clinic remission/unhealed/recurrence were classified as unhealed. Additionally, adverse events and Wexner fecal incontinence score were documented.
RESULTS: Forty-nine patients (40 men and 9 women) with a median age of 26.0 (19.0-35.5) years were included with a median follow-up of 50.0 (39.5-54.0) months. Of these, 31 (63.3%) patients achieved fistula healing, 3 (6.1%) experienced improvement, 3 (6.1%) remained unhealed, and 12 (24.5%) experienced recurrence. Montreal A category was lower in the healed group (P < 0.001). No major complications, such as bleeding or fecal or urinary incontinence, were observed, and pain was transient. The Wexner incontinence score decreased significantly at the last available follow-up, indicating an intact postoperative continence function (P = 0.014). PCDAI scores were significantly higher in the unhealed group (P = 0.041).
CONCLUSIONS: FiLaC™ is an efficient and safe sphincter-saving procedure for patients with complex pfCD.

BACKGROUND: The relationship between fecal incontinence (FI) and type 2 diabetes (T2D) has been well recognized, but a comprehensive understanding of this relationship is lacking, taking into account demographic factors and lifestyle variables.
METHODS: Using a cross-sectional approach, 13,510 adults aged 20 years and older were identified from the 2005-2010 National Health and Nutrition Examination Survey. Multivariate logistic regression models were used to calculate the adjusted odds ratios (ORs), and further subgroup analyses and propensity score analysis were performed to ensure stable results.
RESULTS: Among 13,510 adults, 11.2% had T2D, and 8.8% had FI. We found a strong T2D-FI link (OR: 1.30; 95% CI: 1.09-1.54, P < 0.001), even after adjusting for covariates. Age > 45 was a critical factor, with a stronger T2D-FI association. Sedentary behavior (OR: 1.41; 95% CI: 1.15-1.73) in T2D patients were associated with FI.
CONCLUSIONS: Our study highlights the significant T2D-FI link in US adults, especially in older T2D patients. Lifestyle changes may reduce FI risk. More research is needed for causality and mechanisms.

BACKGROUND: Obstetric anal sphincter injury is a complication of vaginal delivery, if left untreated, causes significant maternal morbidities; urinary problems and fecal/ flatus incontinence. The aim of this study was to determine the incidence and describe the obstetric characteristics and functional outcomes of women who had vaginal delivery at Paropakar Maternity and Women\'s Hospital Nepal and sustained Obstetric anal sphincter injury.
METHODS: This retrospective descriptive study included women who had vaginal delivery, irrespective of parity, in the labor room or birthing unit of Paropakar Maternity and Women\'s Hospital from April 2018 to September 2020, and sustained Grade III or IV Obstetric anal sphincter injury after 28 weeks period of gestation. Maternal characteristics, obstetric details and perineal status after vaginal delivery were noted after review of hospital records. The patients were further inquired via telephone for their current status of fecal and/or urinary incontinence.
RESULTS: The incidence of OASI was 106 (0.33%) among 31, 786 Nepalese women with vaginal birth over a 2-year period. The mean age women with Obstetric anal sphincter injury was 24.6 ± 4.3 years and 45(52.9%) cases belonged to Janajati ethnicity. Fifty two (61.2 %) were primipara and 77 (90.6%) had spontaneous vaginal deliveries. Episiotomy was not performed on most of the patients (63, 74.1%). Problems with flatus holding, stool holding and urine holding was reported by 28.3%, 13.2% and 22.6% women respectively.
CONCLUSIONS: The incidence of Obstetric anal sphincter injury among Nepalese women with vaginal birth over a 2-year period was 0.33%, which was lower than other South Asian studies. Grade III Obstetric anal sphincter injury was the frequent most type. The injuries were more common in women with Janajati ethnicity, primipara and women who did not have episiotomy. Problems with flatus holding and urine holding were present in almost one-fourth of the women with Obstetric anal sphincter injury at follow up.

UNASSIGNED: Patients in intensive care units (ICUs) frequently lose control over their fecal continence leading to fecal incontinence (FI). We provide an overview of existing medical devices, which are supposed to alleviate FI-related problems.
UNASSIGNED: Fecal management systems (FMS) prevent infections and complications. They reduce the risk of pressure ulcers and fecal incontinence. The systems enhance patient comfort and mitigate emotional distress during illness. Furthermore, FMS facilitate nursing care by reducing the incontinence-related workload. Finally, these systems can help minimize treatment costs by preventing complications, and reduction of extended hospital stays and additional treatments. Several well accepted systems made of silicone are on the market. A polyurethane-based soft balloon FMS (hygh-tec® basic-plus) has also been introduced, offering more comfort to the patient, safer handling for the healthcare professionals, and provides reliable leakproof access to the patient\'s colon. In addition to contamination-free fecal diversion, the trans-anal sealing mechanism of the device also allows for irrigation and delivery of medication into the colon.
UNASSIGNED: FMS in ICUs are integral to patient care and dignity. Recognizing and prioritizing the importance of these systems is essential for providing the highest standard of care to critically ill patients in the ICU.