title: Temperature-controlled radiofrequency energy (SECCA) to the anal canal for the treatment of faecal incontinence offers moderate improvement.
abstract: OBJECTIVE
  Faecal incontinence is a devastating complaint. Even after conservative treatment, many patients still remain incontinent. Few patients have a sphincter defect suitable for repair. Other emerging surgical therapies like dynamic gracilis plasty, neuromodulation or artificial bowel sphincter, carry side effects and show only moderate improvement. Temperature-controlled radiofrequency energy (SECCA) has shown promising results in the USA. Local tightening seems to be the mode of action with possible increased rectal sensitivity. We investigated the effectiveness of radiofrequency and possible changes in the anal sphincter with 3D-ultrasound in patients with faecal incontinence.
  
  
  METHODS
  Eleven women, mean age 61 years (49-73) with long-standing faecal incontinence were included. Patients with large sphincter defects and anal stenosis were excluded. The SECCA procedure was performed under conscious sedation and local anaesthesia. Oral antibiotics were given. In four quadrants on four or five levels (depending upon length of the anus) radiofrequency was delivered with multiple needle electrodes. Patients were evaluated at 0, 6 weeks, 3 and 6 months and 1 year. Three-dimensional anal ultrasound was performed at 0 (before and after the procedure), 6 weeks and 3 months. Anal manometry and rectal compliance measurement were performed at 0 and 3 months.
  
  
  RESULTS
  At 3 months, six of 11 patients improved, which persisted during follow-up of 1 year. The Vaizey score changed from 18.8 to 15.0 (P=0.03) and in those improved from 18.3 to 11.5 (P=0.03). Anal manometry and rectal compliance showed no significant changes, there was a tendency to increased rectal sensitivity concerning urge and maximal tolerated volume (both P=0.3). Responders compared with nonresponders showed no difference in test results. Side effects were local haematoma (2), bleeding 3 days (1), pain persisting 1-3 weeks (4) and laxatives-related diarrhoea during 1-3 weeks (4).
  
  
  CONCLUSIONS
  The SECCA procedure seems to be promising for patients with faecal incontinence with a persisting effect after 1 year. No significant changes in tests were found.
authors.affiliation: Department of Gastroenterology and Hepatology, VU University Medical Centre, Amsterdam, The Netherlands. rjf.felt@vumc.nl
authors.forename: Richelle J
authors.initials: RJ
authors.lastname: Felt-Bersma
authors.forename: Maria M
authors.initials: MM
authors.lastname: Szojda
authors.forename: Chris J
authors.initials: CJ
authors.lastname: Mulder
mesh_terms: D000368:Aged; D001003:Anal Canal / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000528:radiation effects*; D003187:Compliance / Q000528:radiation effects; D005242:Fecal Incontinence / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000532:radiotherapy*; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D008365:Manometry; D008875:Middle Aged; D010865:Pilot Projects; D011446:Prospective Studies; D011846:Radio Waves / Q000009:adverse effects; D000078702:Radiofrequency Therapy; D012007:Rectum / Q000503:physiopathology / Q000528:radiation effects; D012720:Severity of Illness Index; D013696:Temperature; D016896:Treatment Outcome; D014463:Ultrasonography