Long-term outcomes of individualized biofeedback training based on the underlying dysfunction for patients with imperforate anus.
BACKGROUND
The aim of this study was to design an individualized biofeedback program based on the underlying dysfunctions and to assess the short-term and long-term clinical and quality-of-life outcomes for patients with imperforate anus.


METHODS
Thirty-one patients were treated using an individualized biofeedback program according to their different dysfunctions after having completed the assessment of the anorectal function. Many special biofeedback training methods that consist of strengthening the perianal muscles biofeedback, sensory discrimination biofeedback, synchronizing external sphincter contraction biofeedback, and improving defecation dynamic biofeedback were selected to make up the individualized biofeedback training program. The clinical scores and quality-of-life scores were assessed in the short-term and long-term follow-up.


RESULTS
The clinical scores and quality-of-life scores of patients before training, after biofeedback training, at short-term follow-up, and at long-term follow-up were 3.2 +/- 1.1 and 8.7 +/- 1.1, 5.2 +/- 0.6 and 11.0 +/- 0.8, 5.1 +/- 0.6 and 10.8 +/- 0.9, and 4.6 +/- 0.7 and 10.1 +/- 0.7, respectively. After biofeedback training, the strength of the perianal muscles were increased significantly, the abnormal rectal threshold sensation and defecation dynamic reverted to normal in all patients, and 82% patients who have no external anal sphincter reflex acquired the new reflex. In the short-term follow-up, 12 (57%) patients maintained the clinical outcome, and only 9 (43%) patients have regressions slightly. At long-term follow-up, 7 (33%) patients maintained the clinical outcome very well, and 14 (67%) patients had regressed. Although the clinical and quality-of-life scores have decreased slightly at follow-up, they were still significantly increased compared with those before biofeedback training.


CONCLUSIONS
The individualized biofeedback is more suitable for improvement of the clinical outcome and the quality of life, and maintained a good clinical outcome and quality of life on the short-term and long-term follow-ups.
Zhengwei
Yuan
Y
Department of Pediatric Surgery, Second Affiliated Hospital of China Medical University, Shenyang 110004, China. yuanzw@hotmail.com
Weilin
Wang
W
Yuzuo
Bai
B
Weisong
Cai
C
Wei
Wang
W
D000293:Adolescent; D000328:Adult; D001003:Anal Canal / Q000503:physiopathology* / Q000601:surgery; D001006:Anus, Imperforate / Q000503:physiopathology / Q000534:rehabilitation* / Q000601:surgery; D001676:Biofeedback, Psychology; D002648:Child; D002675:Child, Preschool; D003248:Constipation / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D003672:Defecation / Q000502:physiology*; D019841:Defecography; D004576:Electromyography; D005242:Fecal Incontinence / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009119:Muscle Contraction; D009129:Muscle Tonus / Q000502:physiology; D009130:Muscle, Smooth / Q000503:physiopathology; D009431:Neural Conduction; D011183:Postoperative Complications / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D011184:Postoperative Period; D011788:Quality of Life; D012003:Rectal Fistula / Q000601:surgery; D012006:Rectovaginal Fistula / Q000601:surgery; D012021:Reflex, Abnormal; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014548:Urinary Fistula / Q000601:surgery