Injectable silicone biomaterial (PTQ) to treat fecal incontinence after hemorrhoidectomy.
OBJECTIVE
Passive fecal incontinence after hemorrhoidectomy may occur and is socially incapacitating. There has been no effective treatment for passive fecal incontinence caused by internal anal sphincter dysfunction. This case series reviewed the outcome of therapy with injectable silicone biomaterial (PTQ) in patients who had passive fecal incontinence after hemorrhoidectomy.


METHODS
From 2003 to 2004, seven patients referred with passive fecal incontinence after hemorrhoidectomy (Milligan-Morgan hemorrhoidectomy n = 5; stapled hemorrhoidectomy n= 2) were treated with injectable PTQ implants. All were assessed with anorectal physiology testing, Wexner continence score, and objective quality of life questionnaires before and after treatment.


RESULTS
The Wexner continence score improved significantly at three months (P= 0.016) after the injectable PTQ implant and continued to improve significantly for up to 12 months (P = 0.016). The global quality of life scores (Visual Analog Scale) showed similar improvement (P = 0.016 at 3 months; P = 0.016 at 12 months). Three domains (life style, coping behavior, and depression/self-perception) of Fecal Incontinence Quality of Life Scale were significantly improved. The manometric studies showed significant improvement in maximum resting anal canal pressures (P= 0.016) after the injectable PTQ implant.


CONCLUSIONS
The injectable silicone biomaterial is an effective treatment for passive fecal incontinence after hemorrhoidectomy providing good medium-term improvement in fecal incontinence and fecal incontinence-related quality of life.
Department of Colorectal Surgery, Royal Melbourne Hospital and Epworth Hospitals, University of Melbourne, Melbourne, Australia.
Miranda K Y
MK
Chan
Joe J
JJ
Tjandra
D000328:Adult; D000368:Aged; D001672:Biocompatible Materials / Q000008:administration & dosage*; D005242:Fecal Incontinence / Q000000981:diagnostic imaging / Q000209:etiology* / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006484:Hemorrhoids / Q000601:surgery*; D006801:Humans; D015552:Injections, Intralesional; D008297:Male; D008875:Middle Aged; D011108:Polymers / Q000008:administration & dosage*; D011183:Postoperative Complications; D011446:Prospective Studies; D016896:Treatment Outcome; D014463:Ultrasonography
D001672:Biocompatible Materials; C068018:Bioplastique; D011108:Polymers