Esfinteroplastia anal en el tratamiento de la incontinencia fecal por trauma obstétrico
técnica quirúrgica y casos clínicos
DOI:
https://doi.org/10.31837/cir.urug/2.2.2Palabras clave:
incontinencia anal, esfinteroplastia anal, esfinteroplastia secundariaResumen
Introducción:
La incontinencia fecal tiene un impacto negativo en la calidad de vida de quienes la padecen. Cuando es de causa miogénica puede estar indicada la esfinteroplastia anal, cuyos resultados suelen ser poco alentadores.
Técnica quirúrgica y casos clínicos:
Se presenta la técnica quirúrgica utilizada en la Clínica Quirúrgica 2 del Hospital Maciel, junto con dos casos clínicos.
Discusión:
La esfinteroplastia anal anterior puede realizarse mediante afrontamiento simple o con técnica deoverlapping, no existiendo evidencia de que alguna de ellas sea superior en cuanto a resultados alejados.
Conclusiones:
Los resultados alejados de la esfinteroplastia anal son pobres, siendo la neuropatía pudenda asociada la que condiciona y puede predecir la mayoría de los fracasos terapéuticos.
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Del Río C, Biondo S, Marti-Rague J. Fecal incontinence. Patient asessment and classical treatments. Cir Esp. 2005; 78: 34-40.
Nelson R, Norton N, Cautley E. Community based prevalence of anal incontinence. J Am MedAssoc. 1995;274(7):559–61
Ditah I, Devaki P, Luma HN. Prevalence, trends, and risk factors for fecal incontinence in United States adults, 2005– 2010. Clin Gastroenterol Hepatol. 2014;12(4):636–43
Brown SJ, Gartland D, Donath S, MacArthur C. Fecal incontinence during the first 12 months postpartum: Complex causal pathways and implications for clinical practice. Obstet Gynecol. 2012;119(2 Pt 1):240–9
Thekkinkattil DK, Lim M, Stojkovic SG, Finan PJ, Sagar PM, Burke D. A classification system for fecal incontinence based on anorectal investigations. Br J Surg 2008; 95: 222-8
Meurette, G. Duchalais, P. Lehur, A. Surgical approaches to fecal incontinence in the adult. J Visc Surg 2014. 151; 29-39
Damon H, Vitton V, Soudan D. Incontinence anale de l’adulte. Paris: Springereds; 2013
Omar MI, Alexander CE. Drug treatment for faecal incontinence in adults. Cochrane Database Syst Rev. 2013;6
Santos KL, Cavenaghi S, Roselli AE, Carvalho LH, Martins P, Ferreira LL, et al. Effects of biofeedback in the treatment of female fecal incontinence. J Coloproctol (Rio J). 2018.https://doi.org/10.1016/j.jcol.2018.03.008
Stedenfeldt M, Pirhonen J, Blix E, Wilsgaard T, Vonen B, Øian P. Episiotomy characteristics and risks for obstetric anal sphincter injuries: A case-control study. BJOG. 2012;119:724– 30
Fitzpatrick M, O’Brien C, O’Connell PR, O’Herlihy C. Patterns of abnormal pudendal nerve function that are associated with post partum fecal incontinence. Am J Obstet Gynecol. 2003;189:730–5
Zetterström J, López A, Holmström B, Nilsson BY, Tisell A, Anzén B, et al. Obstetric sphincter tears and anal incontinence: An observational follow-up study. Obstet Gynecol Scand 2003; 82: 921-8
Hehir MP, O ? Connor HD, Higgins S, Robson MS, McAuliffe FM, Boylan PC, et al. Obstetric anal sphincter injury, risk factors and method of delivery- an 8-year analysis across two tertiary referral centers. J Matern Fetal Neonatal Med. 2013;26:1514–6.
Malek-mellouli M, Assen S, Ben Amara F, Gada H, Masmoudi K, Reziga H. Incidence and risk factors of postpartum anal incontinence: A prospective study of 503 cases. Tunis Med. 2014;92:159–63
Sultan AH, Thakar R. Lower genital tract and anal sphincter trauma. Best Practice & Research in Clinical Obstetrics & Gynaecology 2002;16:99–115
Sultan AH. Obstetric perineal injury and anal incontinence. ClinicalRisk1999;5:193–6
Brown SJ, Gartland D, Donath S, MacArthur C. Fecal incontinence during the first 12 months postpartum: Complex causal pathways and implications for clinical practice. Obstet Gynecol. 2012;119(2 Pt 1):240–9
Sultan AH, Kamm MA, Hudson CN, Thomas JM, Bartram CI. Anal-sphincter disruption during vaginal delivery. Engl J Med. 1993;329:1905–11.
Jorge JMN, Wexner SD. Etiology and management of faecal incontinence. Diseases of the Colon &Rectum1993;36(1): 77–97
Nicholls J. Sphincter repair for incontinence. Colorectal Dis. 2009;11:545–6
Bharucha AE, Fletcher JG. Recent advances in assessing anorectal structure and functions. Gastroenterology. 2007;133:1069–74
Heinrich, H. Misselwitz, B. High-resolution anorectal manometry. New insights in the diagnostic assessment of anorectal disorders. Visc Med 2018;34:134–9
Hardcastle JD, Parks AG. A study of anal incontinence and some principles of surgical treatment. Proc R Soc Med. 1970;63:116–8
Tjandra JJ, Dykes SL, Kumar RR, Ellis CN, Gregorcyk SG, Hyman NH, et al. Practice parameters for the treatment of fecal incontinence. Dis Colon Rectum. 2007;50:1497–507
Starck M, Bohe M, Valentin L. The extent of endosonographic anal sphincter defects after primary repair of obstetric sphincter tears increases over time and is related to anal incontinence. Ultrasound Obstet Gynecol. 2006;27:188–97
WexnerSD, Coller JA, Devroede G. Sacral nerve stimulation for fecal incontinence: results of a 120-patient prospective multicenter study. Ann Surg 2010;251:441-9
Wong MT, Meurette G, Rodat F. Outcome and management of patients in whom sacral nerve stimulation for fecal incontinent cefailed. Dis Colon Rectum 2011;54:425-32
Thin NN, Horrocks EJ, Hotouras A. Systematic review of the clinical effectiveness of neuromodulation in the treatment of faecal incontinence. Br J Surg. 2013:1001430–47
Luo C, Samaranayake CB,Plank LD. Systematic review on the efficacy and safety of injectable bulking agents for passive faecal incontinence. Colorectal Dis. 2010;12:296–303
Wong MT, Meurette G, Wyart V, Glemain P, Lehur PA. The artificial bowel sphincter: a single institution experience over a decade. Ann Surg2011;254:951-6.
Fernando RJ, Sultan AH, Kettle C, Thakar R. Methods of repairfor obstetric anal sphincter injury. Cochrane Database of SystematicReviews2013, Issue 12.
Ogilvie JW, Maddof RD. Sphincteroplasty. In: Ratto C, Doglietto GB, editors. Fecal incontinence diagnosis and treatment. SpringerVerlag: Milan; 2007. p. 171–5
Oberwalder M, Dinnewitzer A, Baig MK, Nogueras JJ, Weiss EG, Efron J, et al. Do internal anal sphincter defects decrease the successrate of anal sphincter repair? Tech Coloproctol. 2006;10:94–7
Hasegawa H, Yoshioka K, Keighley MR. Randomized trial of fecal diversion for sphincter repair. Dis Colon Rectum. 2000;43:961–4
Nessim A, Wexner SD, Agachan F, Alabaz O, Weiss EG, Nogueras JJ, et al. Is bowel confinement necessary after anorectal reconstructive surgery? A prospective, randomized, surgeon-blinded trial Dis Colon Rectum. 1999;42:16–23.
Tan JJ, Chan M, Tjandra JJ. Evolving therapy for fecal incontinence. Dis Colon Rectum. 2007;50:1950–67
Glasgow SC, Lowry AC. Long-term outcomes of anal sphincter repair for fecal incontinence: a systematic review. Dis Colon Rectum. 2012;55:482–90
Lamblin G, Bouvier P, Damon H, Chabert P. Long-term out come after overlapping anterior anal sphincter repair for fecal incontinence. Int J Colorectal Dis. 2014;29:1377–83
McManus, B.P., Allison, S. & Hernández-Sánchez, J. Anterior sphincteroplasty for fecal incontinence: predicting incontinence relapse. Int J Colorectal Dis 2015. 30:513–20
Gilliland R, Altomare DF, Moreira Jr. H, Oliveira L, Gilliland JE, Wexner SD. Pudendal neuropathy is predictive of failure following anterior overlapping sphincteroplasty. Dis Colon Rectum. 1998;41:1516–22
Oom DM, Steensma AB, Zimmerman DD, Schouten WR. Anterior sphincteroplasty for fecal incontinence: is the outcome compromised in patients with associated pelvic floor injury? Dis Colon Rectum. 2010;53:150-5
Nordenstam J, Mellgren A, Altman D, Lopez A, Johansson C, Anze ?n B, Li Z, Zetterström J. Immediate or delayed repair of obstetric anal sphincter tears. A randomized controlled trial. BJOG 2008;115:857–65.
Nelson R, Norton N, Cautley E. Community based prevalence of anal incontinence. J Am MedAssoc. 1995;274(7):559–61
Ditah I, Devaki P, Luma HN. Prevalence, trends, and risk factors for fecal incontinence in United States adults, 2005– 2010. Clin Gastroenterol Hepatol. 2014;12(4):636–43
Brown SJ, Gartland D, Donath S, MacArthur C. Fecal incontinence during the first 12 months postpartum: Complex causal pathways and implications for clinical practice. Obstet Gynecol. 2012;119(2 Pt 1):240–9
Thekkinkattil DK, Lim M, Stojkovic SG, Finan PJ, Sagar PM, Burke D. A classification system for fecal incontinence based on anorectal investigations. Br J Surg 2008; 95: 222-8
Meurette, G. Duchalais, P. Lehur, A. Surgical approaches to fecal incontinence in the adult. J Visc Surg 2014. 151; 29-39
Damon H, Vitton V, Soudan D. Incontinence anale de l’adulte. Paris: Springereds; 2013
Omar MI, Alexander CE. Drug treatment for faecal incontinence in adults. Cochrane Database Syst Rev. 2013;6
Santos KL, Cavenaghi S, Roselli AE, Carvalho LH, Martins P, Ferreira LL, et al. Effects of biofeedback in the treatment of female fecal incontinence. J Coloproctol (Rio J). 2018.https://doi.org/10.1016/j.jcol.2018.03.008
Stedenfeldt M, Pirhonen J, Blix E, Wilsgaard T, Vonen B, Øian P. Episiotomy characteristics and risks for obstetric anal sphincter injuries: A case-control study. BJOG. 2012;119:724– 30
Fitzpatrick M, O’Brien C, O’Connell PR, O’Herlihy C. Patterns of abnormal pudendal nerve function that are associated with post partum fecal incontinence. Am J Obstet Gynecol. 2003;189:730–5
Zetterström J, López A, Holmström B, Nilsson BY, Tisell A, Anzén B, et al. Obstetric sphincter tears and anal incontinence: An observational follow-up study. Obstet Gynecol Scand 2003; 82: 921-8
Hehir MP, O ? Connor HD, Higgins S, Robson MS, McAuliffe FM, Boylan PC, et al. Obstetric anal sphincter injury, risk factors and method of delivery- an 8-year analysis across two tertiary referral centers. J Matern Fetal Neonatal Med. 2013;26:1514–6.
Malek-mellouli M, Assen S, Ben Amara F, Gada H, Masmoudi K, Reziga H. Incidence and risk factors of postpartum anal incontinence: A prospective study of 503 cases. Tunis Med. 2014;92:159–63
Sultan AH, Thakar R. Lower genital tract and anal sphincter trauma. Best Practice & Research in Clinical Obstetrics & Gynaecology 2002;16:99–115
Sultan AH. Obstetric perineal injury and anal incontinence. ClinicalRisk1999;5:193–6
Brown SJ, Gartland D, Donath S, MacArthur C. Fecal incontinence during the first 12 months postpartum: Complex causal pathways and implications for clinical practice. Obstet Gynecol. 2012;119(2 Pt 1):240–9
Sultan AH, Kamm MA, Hudson CN, Thomas JM, Bartram CI. Anal-sphincter disruption during vaginal delivery. Engl J Med. 1993;329:1905–11.
Jorge JMN, Wexner SD. Etiology and management of faecal incontinence. Diseases of the Colon &Rectum1993;36(1): 77–97
Nicholls J. Sphincter repair for incontinence. Colorectal Dis. 2009;11:545–6
Bharucha AE, Fletcher JG. Recent advances in assessing anorectal structure and functions. Gastroenterology. 2007;133:1069–74
Heinrich, H. Misselwitz, B. High-resolution anorectal manometry. New insights in the diagnostic assessment of anorectal disorders. Visc Med 2018;34:134–9
Hardcastle JD, Parks AG. A study of anal incontinence and some principles of surgical treatment. Proc R Soc Med. 1970;63:116–8
Tjandra JJ, Dykes SL, Kumar RR, Ellis CN, Gregorcyk SG, Hyman NH, et al. Practice parameters for the treatment of fecal incontinence. Dis Colon Rectum. 2007;50:1497–507
Starck M, Bohe M, Valentin L. The extent of endosonographic anal sphincter defects after primary repair of obstetric sphincter tears increases over time and is related to anal incontinence. Ultrasound Obstet Gynecol. 2006;27:188–97
WexnerSD, Coller JA, Devroede G. Sacral nerve stimulation for fecal incontinence: results of a 120-patient prospective multicenter study. Ann Surg 2010;251:441-9
Wong MT, Meurette G, Rodat F. Outcome and management of patients in whom sacral nerve stimulation for fecal incontinent cefailed. Dis Colon Rectum 2011;54:425-32
Thin NN, Horrocks EJ, Hotouras A. Systematic review of the clinical effectiveness of neuromodulation in the treatment of faecal incontinence. Br J Surg. 2013:1001430–47
Luo C, Samaranayake CB,Plank LD. Systematic review on the efficacy and safety of injectable bulking agents for passive faecal incontinence. Colorectal Dis. 2010;12:296–303
Wong MT, Meurette G, Wyart V, Glemain P, Lehur PA. The artificial bowel sphincter: a single institution experience over a decade. Ann Surg2011;254:951-6.
Fernando RJ, Sultan AH, Kettle C, Thakar R. Methods of repairfor obstetric anal sphincter injury. Cochrane Database of SystematicReviews2013, Issue 12.
Ogilvie JW, Maddof RD. Sphincteroplasty. In: Ratto C, Doglietto GB, editors. Fecal incontinence diagnosis and treatment. SpringerVerlag: Milan; 2007. p. 171–5
Oberwalder M, Dinnewitzer A, Baig MK, Nogueras JJ, Weiss EG, Efron J, et al. Do internal anal sphincter defects decrease the successrate of anal sphincter repair? Tech Coloproctol. 2006;10:94–7
Hasegawa H, Yoshioka K, Keighley MR. Randomized trial of fecal diversion for sphincter repair. Dis Colon Rectum. 2000;43:961–4
Nessim A, Wexner SD, Agachan F, Alabaz O, Weiss EG, Nogueras JJ, et al. Is bowel confinement necessary after anorectal reconstructive surgery? A prospective, randomized, surgeon-blinded trial Dis Colon Rectum. 1999;42:16–23.
Tan JJ, Chan M, Tjandra JJ. Evolving therapy for fecal incontinence. Dis Colon Rectum. 2007;50:1950–67
Glasgow SC, Lowry AC. Long-term outcomes of anal sphincter repair for fecal incontinence: a systematic review. Dis Colon Rectum. 2012;55:482–90
Lamblin G, Bouvier P, Damon H, Chabert P. Long-term out come after overlapping anterior anal sphincter repair for fecal incontinence. Int J Colorectal Dis. 2014;29:1377–83
McManus, B.P., Allison, S. & Hernández-Sánchez, J. Anterior sphincteroplasty for fecal incontinence: predicting incontinence relapse. Int J Colorectal Dis 2015. 30:513–20
Gilliland R, Altomare DF, Moreira Jr. H, Oliveira L, Gilliland JE, Wexner SD. Pudendal neuropathy is predictive of failure following anterior overlapping sphincteroplasty. Dis Colon Rectum. 1998;41:1516–22
Oom DM, Steensma AB, Zimmerman DD, Schouten WR. Anterior sphincteroplasty for fecal incontinence: is the outcome compromised in patients with associated pelvic floor injury? Dis Colon Rectum. 2010;53:150-5
Nordenstam J, Mellgren A, Altman D, Lopez A, Johansson C, Anze ?n B, Li Z, Zetterström J. Immediate or delayed repair of obstetric anal sphincter tears. A randomized controlled trial. BJOG 2008;115:857–65.
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Publicado
2019-07-15
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1.
Chinelli J, Costa JM, Rodríguez G. Esfinteroplastia anal en el tratamiento de la incontinencia fecal por trauma obstétrico: técnica quirúrgica y casos clínicos. Cir. Urug. [Internet]. 15 de julio de 2019 [citado 18 de abril de 2024];2(2):12-25. Disponible en: https://revista.scu.org.uy/index.php/cir_urug/article/view/41
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