title: Effectiveness of biofeedback therapy in the treatment of anterior resection syndrome after rectal cancer surgery.
abstract: BACKGROUND
  Although anterior resection syndrome commonly occurs after anal sphincter-saving surgery, no standard treatment option is currently available.
  
  
  OBJECTIVE
  The aim of the present study was to evaluate the clinical effectiveness of biofeedback in patients with anterior resection syndrome after sphincter-saving surgery for rectal cancer.
  
  
  METHODS
  This study was a retrospective review of data collected during the course of treatment.
  
  
  METHODS
  Patients were treated at a teaching hospital (Asan Medical Center) in Seoul, Korea, from January 2003 through December 2008.
  
  
  METHODS
  Patients who received biofeedback therapy for anterior resection syndrome after rectal cancer surgery were included.
  
  
  METHODS
  The Cleveland Clinic Florida fecal incontinence score, number of bowel movements per day, a visual analog scale for assessing patient satisfaction, and anorectal manometry were used to assess outcome of biofeedback treatment.
  
  
  RESULTS
  : After biofeedback therapy, significant improvements were observed in fecal incontinence score (P < .001), number of bowel movements (P < .001), and anorectal manometry data (maximum resting pressure, P = .010; maximum squeeze pressure, P = .006; rectal capacity, P = .003). Compared with patients who started biofeedback treatment less than 18 months after surgery, those who started biofeedback at 18 months or longer after surgery showed greater improvements in fecal incontinence score (P = .032). Only patients with fecal incontinence as the primary symptom showed significant improvements in all variables, including fecal incontinence score, P < .001; defecation frequency, P < .001; and anorectal manometry (maximum resting pressure, P = .027; maximum squeeze pressure, P = .021; rectal capacity, P = .004). Patients who received radiation therapy in addition to surgery reported a significantly higher satisfaction score than those receiving surgery alone (P = .041).
  
  
  CONCLUSIONS
  This is a nonrandomized retrospective study. Anorectal manometry was not regularly performed in all patients.
  
  
  CONCLUSIONS
  Biofeedback therapy produced significant clinical benefits for patients with severe fecal incontinence and may be an effective treatment for patients with anterior resection syndrome after surgery for rectal cancer.
authors.affiliation: Department of Colon and Rectal Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Korea.
authors.forename: Kyung Ho
authors.initials: KH
authors.lastname: Kim
authors.forename: Chang Sik
authors.initials: CS
authors.lastname: Yu
authors.forename: Yong Sik
authors.initials: YS
authors.lastname: Yoon
authors.forename: Sang Nam
authors.initials: SN
authors.lastname: Yoon
authors.forename: Seok-Byung
authors.initials: SB
authors.lastname: Lim
authors.forename: Jin Cheon
authors.initials: JC
authors.lastname: Kim
mesh_terms: D000328:Adult; D000368:Aged; D001676:Biofeedback, Psychology; D016009:Chi-Square Distribution; D004576:Electromyography; D005242:Fecal Incontinence / Q000628:therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D011183:Postoperative Complications / Q000628:therapy*; D012004:Rectal Neoplasms / Q000601:surgery*; D012189:Retrospective Studies; D013577:Syndrome; D016896:Treatment Outcome