Transcript PowerPoint template - Royal College of Surgeons of Edinburgh

The use of PTQ anal bulking
injections
Kirsty Cattle
Pelvic floor clinical fellow
Introduction to treatment of faecal
incontinence
– Heterogenous condition, multiple treatments
available, often disappointing results
– Conservative:
–
Alteration of stool consistency, physiotherapy,
biofeedback
– Surgical:
–
–
Anterior sphincter repair, postanal repair,
stimulated graciloplasty, artificial bowel sphincter
Sacral nerve stimulation, anal bulking injections
images
– Authors:
– Professor Yik-Hong Ho:
• Head of surgery, school of Medicine, James Cook
University, Townsville, Queensland, Australia
– Journal:
– British Journal of Surgery:
• Impact factor 4.921
Introduction & aim
– Problem:
–
Serving a large rural area, long waiting list for
biofeedback, only one colorectal surgeon
– Aim:
–
to document the outcomes, in the short and
medium term, from a large case series of
patients with faecal incontinence and IAS
dysfunction who received PTQ implants over a
4-year interval
Methods
– Identification of patients
–
–
IAS defects or dysfunction, either alone or in
combination
Those unfit for surgery or opted for PTQ
– Surgical method
– Assessment of results
–
–
Anorectal physiology, standard symptom
assessment tools, QoL
At baseline and 6 weeks
– Statistical method
Results
– 74 patients
– 28 (14.5 – 42) months follow up
– At 6 weeks follow up:
–
70 (95%) improved, 42 (57%) cured
– At December 2008 follow up:
–
–
40 of the 42 “cured” patients remain fully
continent
Further 12 now “cured”
– Symptom scores & QoL
–
Both improved at 6 weeks and Dec 2008
– Satisfaction with procedure
–
–
Improve with time in those achieving complete
continence
High, but do not improve in those with remaining
incontinence
– Anal manometry
–
Significant rise in resting pressure, more so in
those achieving continence
– EAUS
–
–
Implants not intact in 10 of 70 patients
Further 2 had late migration of implants
– Complications
–
–
–
–
–
Required antidiarrhoeal medication (n=2)
Constipation (n=1)
Infection (n=1)
Anal irritation or discomfort (n=3)
Superficial mucosal ulceration (n=1)
– Risk factors predictive of poor outcome:
–
–
–
–
–
Pudendal neuropathy
Previous sphincter repair
Previous or subsequent biofeedback therapy
Migrated implants on EAUS
Female sex
Discussion
– Comparison with other studies of PTQ:
–
They claim better results and longer follow up
– Improved anal manometry
– Rate of implant migration:
–
Improved during study period
– Study design
– Cost implications
– Alternatives
Conclusion
–
–
–
–
Effective
Safe
Careful patient selection
Meticulous surgical technique
Critique
– Poor scientific technique, but pragmatic
approach in their setting
– Surprising improvement in continence
scores