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International Journal of Colorectal Disease
Published in: International Journal of Colorectal Disease 2/2008

Open Access 01-02-2008 | Original ARticle

Colonic irrigation for defecation disorders after dynamic graciloplasty

Authors: Sacha M. Koch, Özenç Uludağ, Kadri El Naggar, Wim G. van Gemert, Cor G. Baeten

Published in: International Journal of Colorectal Disease | Issue 2/2008

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Abstract

Background and aims

Dynamic graciloplasty (DGP) improves anal continence and quality of life for most patients. However, in some patients, DGP fails and fecal incontinence is unsolved or only partially improved. Constipation is also a significant problem after DGP, occurring in 13–90%. Colonic irrigation can be considered as an additional or salvage treatment for defecation disorders after unsuccessful or partially successful DGP. In this study, the effectiveness of colonic irrigation for the treatment of persistent fecal incontinence and/or constipation after DGP is investigated.

Materials and methods

Patients with defecation disorders after DGP visiting the outpatient clinic of the University Hospital Maastricht were selected for colonic irrigation as additional therapy or salvage therapy in the period between January 1999 and June 2003. The Biotrol® Irrimatic pump or the irrigation bag was used for colonic irrigation. Relevant physical and medical history was collected. The patients were asked to fill out a detailed questionnaire about colonic irrigation.

Results

Forty-six patients were included in the study with a mean age of 59.3 ± 12.4 years (80% female). On average, the patients started the irrigation 21.39 ± 38.77 months after the DGP. Eight patients started irrigation before the DGP. Fifty-two percent of the patients used the irrigation as additional therapy for fecal incontinence, 24% for constipation, and 24% for both. Irrigation was usually performed in the morning. The mean frequency of irrigation was 0.90 ± 0.40 times per day. The mean amount of water used for the irrigation was 2.27 ± 1.75 l with a mean duration of 39 ± 23 min. Four patients performed antegrade irrigation through a colostomy or appendicostomy, with good results. Overall, 81% of the patients were satisfied with the irrigation. Thirty-seven percent of the patients with fecal incontinence reached (pseudo-)continence, and in 30% of the patients, the constipation completely resolved. Side effects of the irrigation were reported in 61% of the patients: leakage of water after irrigation, abdominal cramps, and distended abdomen. Seven (16%) patients stopped the rectal irrigation.

Conclusion

Colonic irrigation is an effective alternative for the treatment of persistent fecal incontinence after DGP and/or recurrent or onset constipation additional to unsuccessful or (partially) successful DGP.
Literature
1.
Mavrantonis C, Billotti VL, Wexner SD (1999) Stimulated graciloplasty for treatment of intractable fecal incontinence: critical influence of the method of stimulation. Dis Colon Rectum 42:497–504PubMedCrossRef
2.
Wexner SD, Baeten C, Bailey R et al (2002) Long-term efficacy of dynamic graciloplasty for fecal incontinence. Dis Colon Rectum 45:809–818PubMedCrossRef
3.
Baeten CG, Bailey HR, Bakka A et al (2000) Safety and efficacy of dynamic graciloplasty for fecal incontinence: report of a prospective, multicenter trial. Dynamic Graciloplasty Therapy Study Group. Dis Colon Rectum 43:743–751PubMedCrossRef
4.
Chapman AE, Geerdes B, Hewett P et al (2002) Systematic review of dynamic graciloplasty in the treatment of faecal incontinence. Br J Surg 89:138–153PubMed
5.
Penninckx F (2004) Belgian experience with dynamic graciloplasty for faecal incontinence. Br J Surg 91:872–878PubMedCrossRef
6.
Ortiz H, Armendariz P, DeMiguel M et al (2003) Prospective study of artificial anal sphincter and dynamic graciloplasty for severe anal incontinence. Int J Colorectal Dis 18:349–354PubMed
7.
Baeten CG, Geerdes BP, Adang EM et al (1995) Anal dynamic graciloplasty in the treatment of intractable fecal incontinence. N Engl J Med 332:1600–1605PubMedCrossRef
8.
Thornton MJ, Kennedy ML, Lubowski DZ et al (2004) Long-term follow-up of dynamic graciloplasty for faecal incontinence. Colorectal Dis 6:470–476PubMedCrossRef
9.
Geerdes BP, Heineman E, Konsten J et al (1996) Dynamic graciloplasty. Complications and management. Dis Colon Rectum 39:912–917PubMedCrossRef
10.
Madoff RD, Rosen HR, Baeten CG et al (1999) Safety and efficacy of dynamic muscle plasty for anal incontinence: lessons from a prospective, multicenter trial. Gastroenterology 116:549–556PubMedCrossRef
11.
Matzel KE, Madoff RD, LaFontaine LJ et al (2001) Complications of dynamic graciloplasty: incidence, management, and impact on outcome. Dis Colon Rectum 44:1427–1435PubMedCrossRef
12.
Rosen HR, Urbarz C, Novi G et al (2002) Long-term results of modified graciloplasty for sphincter replacement after rectal excision. Colorectal Dis 4:266–269PubMedCrossRef
13.
Briel JW, Schouten WR, Vlot EA et al (1997) Clinical value of colonic irrigation in patients with continence disturbances. Dis Colon Rectum 40:802–805PubMedCrossRef
14.
Christensen P, Olsen N, Krogh K et al (2003) Scintigraphic assessment of retrograde colonic washout in fecal incontinence and constipation. Dis Colon Rectum 46:68–76PubMedCrossRef
15.
Kokoska ER, Keller MS, Weber TR (2001) Outcome of the antegrade colonic enema procedure in children with chronic constipation. Am J Surg 182:625–629PubMedCrossRef
16.
Cascio S, Flett ME, De la Hunt M et al (2004) MACE or caecostomy button for idiopathic constipation in children: a comparison of complications and outcomes. Pediatr Surg Int 20:484–487PubMedCrossRef
17.
Schell SR, Toogood GJ, Dudley NE (1997) Control of fecal incontinence: continued success with the Malone procedure. Surgery 122:626–631PubMedCrossRef
18.
Gosselink MP, Darby M, Zimmerman DD et al (2005) Long-term follow-up of retrograde colonic irrigation for defaecation disturbances. Colorectal Dis 7:65–69PubMedCrossRef
19.
Wolters U, Keller HW, Sorgatz S et al (1994) Prospective randomized study of preoperative bowel cleansing for patients undergoing colorectal surgery. Br J Surg 81:598–600PubMedCrossRef
20.
Vincent MV, Marven SS (2004) Intraoperative colonic lavage in infants using a Replogle tube. Pediatr Surg Int 20:562–563PubMedCrossRef
21.
Malone PS, Ransley PG, Kiely EM (1990) Preliminary report: the antegrade continence enema. Lancet 336:1217–1218PubMedCrossRef
22.
Malone PS, Curry JI, Osborne A (1998) The antegrade continence enema procedure why, when and how. World J Urol 16:274–278PubMedCrossRef
23.
Rongen MJ, van der Hoop AG, Baeten CG (2001) Cecal access for antegrade colon enemas in medically refractory slow-transit constipation: a prospective study. Dis Colon Rectum 44:1644–1649PubMedCrossRef
24.
Gauderer MW, Decou JM, Boyle JT (2002) Sigmoid irrigation tube for the management of chronic evacuation disorders. J Pediatr Surg 37:348–351PubMedCrossRef
25.
Heriot AG, Tilney HS, Simson JN (2002) The application of percutaneous endoscopic colostomy to the management of obstructed defecation. Dis Colon Rectum 45:700–702PubMedCrossRef
26.
Hughes SF, Williams NS (1995) Continent colonic conduit for the treatment of faecal incontinence associated with disordered evacuation. Br J Surg 82:1318–1320PubMedCrossRef
27.
O’Bichere A, Sibbons P, Dore C et al (2002) Experimental study of faecal continence and colostomy irrigation. Br J Surg 87:902–908CrossRef
28.
Vaizey CJ, Kamm MA, Roy AJ et al (2000) Double-blind crossover study of sacral nerve stimulation for fecal incontinence. Dis Colon Rectum 43:298–302PubMedCrossRef
29.
Matzel KE, Stadelmaier U, Hohenfellner M et al (1995) Electrical stimulation of sacral spinal nerves for treatment of faecal incontinence. Lancet 346:1124–1127PubMedCrossRef
30.
Uludag O, Darby M, Dejong CH et al (2002) Sacral neuromodulation is effective in the treatment of fecal incontinence with intact sphincter muscles; a prospective study. Ned Tijdschr Geneeskd 146:989–993PubMed
31.
Rotholtz NA, Wexner SD (2001) Surgical treatment of constipation and fecal incontinence. Gastroenterol Clin North Am 30:131–166PubMedCrossRef
32.
Uludag O, Koch SM, van Gemert WG et al (2004) Sacral Neuromodulation in patients with fecal incontinence, a single centre study. Dis Col Rectum 47:1350–1357CrossRef
33.
Koch SM, Uludag O, Rongen MJ et al (2004) Dynamic graciloplasty in patients born with anal atresia. Dis Colon Rectum 47:1711–1719PubMedCrossRef
34.
Mander BJ, Wexner SD, Williams NS et al (1999) Preliminary results of a multicentre trial of the electrically stimulated gracilis neoanal sphincter. Br J Surg 86:1543–1548PubMedCrossRef
35.
Geerdes BP, Konsten J, Baeten CG (1996) Constipation after dynamic graciloplasty. Dis Colon Rectum 39:943PubMedCrossRef
36.
Christiansen J, Rasmussen O, Lindorff-Larsen K (1998) Dynamic graciloplasty for severe anal incontinence. Br J Surg 85:88–91PubMedCrossRef
37.
38.
Norton C, Burch J, Kamm MA (2005) Patients’ views of a colostomy for fecal incontinence. Dis Col Rectum 48:1062–1069CrossRef
39.
Harris R, Daly K, Jones L, Kiff E (2004) Stoma formation for functional bowel disease. Colorectal Dis 6:280–284PubMedCrossRef
40.
Black P (2004) Psychological, sexual and cultural issues for patients with a stoma. Br J Nurs 13:692–697PubMed
Metadata
Title
Colonic irrigation for defecation disorders after dynamic graciloplasty
Authors
Sacha M. Koch
Özenç Uludağ
Kadri El Naggar
Wim G. van Gemert
Cor G. Baeten
Publication date
01-02-2008
Publisher
Springer-Verlag
Published in
International Journal of Colorectal Disease / Issue 2/2008
Print ISSN: 0179-1958
Electronic ISSN: 1432-1262
DOI
https://doi.org/10.1007/s00384-007-0375-y

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