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Techniques in Coloproctology

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01-12-2020 | Sleeve Gastrectomy | Original Article

A prospective study of anal symptoms and continence among obese patients before and after bariatric surgery

Authors: A. L. Pelletier, A. Boukris, S. Karunakaran, F. Dib, C. Laouénan, B. Hansel, K. Arapis, L. Abramowitz

Published in: Techniques in Coloproctology | Issue 12/2020

Abstract

Background

The effects of bariatric surgery on anal continence are not known. Data about proctologic lesions are very rare and do not include clinical data. The aim of this prospective study was to evaluate anal continence and anal lesions before and after sleeve gastrectomy (SG).

Methods

We prospectively included all patients presenting for bariatric surgery consultation at Bichat-Claude Bernard University Hospital, Paris, France, between 20 April 2015 and 16 December 2017. The patients were evaluated with questionnaires, anorectal manometry and clinical examination before SG (at enrollment) and between 12 and 24 months after (SG). Anal incontinence was defined as a Vaizey score above 4.

Results

Of 118 enrolled patients, 98 had SG. The patients were mostly women (n = 99, 84.6%). Median patient age was 45 years (IQR 34–54 years). The median follow-up period after surgery among the 86 patients who completed follow-up was 15 months (IQR 12.5–17.3 months). There was no significant change in the prevalence of anal incontinence after SG (12.8% preoperatively vs 24.4% postoperatively, p = 0.06). The median Vaizey score was 4 (IQR 4–4) both before and after SG (p = 0.1). No patient had de novo anal incontinence but worsening of anal incontinence was noted in 10 patients. Manometry revealed significantly lower median resting pressure (29 mmHg [IQR 22–68 mmHg] vs 22 mmHg [IQR 15–30 mmHg], p = 0.0015) and maximal squeeze pressure (IQR 29–74 mmHg vs IQR 30–60 mmHg, p = 0.0008) after SG. Anismus was more frequent after SG and was associated with constipation and Bristol type 1–2 stool consistency. Quality of life was unchanged. Proctologic lesions were rare and were present in 11 patients (12%) at enrollment and in 2 (2.4%) at follow-up.

Conclusions

SG affected clinical anal continence but not significantly, and manometric measurements for anal pressures were lower postoperatively. Proctologic lesions were rare in this study population.

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Title: A prospective study of anal symptoms and continence among obese patients before and after bariatric surgery
Authors: A. L. Pelletier
A. Boukris
S. Karunakaran
F. Dib
C. Laouénan
B. Hansel
K. Arapis
L. Abramowitz
Publication date: 01-12-2020
Publisher: Springer International Publishing
Keywords: Sleeve Gastrectomy
Constipation
Bariatric Surgery
Bariatric Surgery
Hemorrhoids
Fecal Incontinence
Constipation
Anal Fissure
Published in: Techniques in Coloproctology / Issue 12/2020
Print ISSN: 1123-6337
Electronic ISSN: 1128-045X
DOI: https://doi.org/10.1007/s10151-020-02316-4

At a glance: The STEP trials

Springer Medicine

A prospective study of anal symptoms and continence among obese patients before and after bariatric surgery

Abstract

Background

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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