title: Prevalence of defaecatory disorders in morbidly obese patients before and after bariatric surgery.
abstract: BACKGROUND
  The prevalence of obesity is increasing worldwide and has lately reached epidemic proportions in western countries. Several epidemiological studies have consistently shown that both overweight and obesity are important risk factors for the development of various functional defaecatory disorders (DDs), including faecal incontinence and constipation. However, data on their prevalence as well as effectiveness of bariatric surgery on their correction are scant. The primary objective of this study was to estimate the effect of morbid obesity on DDs in a cohort of patients listed for bariatric surgery. We also evaluated preliminary results of the effects of sleeve gastrectomy on these disorders.
  
  
  METHODS
  A questionnaire-based study was proposed to morbidly obese patients having bariatric surgery. Data included demographics, past medical, surgical and obstetrics histories, as well as obesity related co-morbidities. Wexner Constipation Score (WCS) and the Faecal Incontinence Severity Index (FISI) questionnaires were used to evaluate constipation and incontinence. For the purpose of this study, we considered clinically relevant a WCS ≥5 and a FISI score ≥10. The same questionnaires were completed at 3 and 6 months follow-up after surgery.
  
  
  RESULTS
  A total of 139 patients accepted the study and 68 underwent sleeve gastrectomy and fully satisfied our inclusion criteria with a minimum follow-up of 6 months. Overall, mean body mass index (BMI) at listing was 47 ± 7 kg/m(2) (range 35-67 kg/m(2)). Mean WCS was 4.1 ± 4 (range 0-17), while mean FISI score (expressed as mean±standard deviation) was 9.5 ± 9 (range 0-38). Overall, 58.9% of the patients reported DDs according to the above-mentioned scores. Twenty-eight patients (20%) had WCS ≥5. Thirty-five patients (25%) had a FISI ≥10 while 19 patients (13.7%) reported combined abnormal scores. Overall, DDs were more evident with the increase of obesity grade: Mean BMI decreased significantly from 47 ± 7 to 36 ± 6 and to 29 ± 4 kg/m(2) respectively at 3 and 6 months after surgery (p < 0.0001). According to the BMI decrease, the mean WCS decreased from 3.7 ± 3 to 3.1 ± 4 and to 1.6 ± 3 respectively at 3 and 6 months (p = 0.02). Similarly, the FISI score decreased from 10 ± 8 to 3 ± 4 and to 1 ± 2 respectively at 3 and 6 months (p = 0.0001).
  
  
  CONCLUSIONS
  Defaecatory disorders are common in morbidly obese patients. The risk of DDs increases with BMI. Bariatric surgery reduces DDs, mainly faecal incontinence, and these findings correlated with BMI reduction.
authors.affiliation: Department of Surgical Sciences, University of Rome Tor Vergata, Rome, Italy. piersileri@yahoo.com
authors.forename: Pierpaolo
authors.initials: P
authors.lastname: Sileri
authors.forename: Luana
authors.initials: L
authors.lastname: Franceschilli
authors.forename: Federica
authors.initials: F
authors.lastname: Cadeddu
authors.forename: Elisabetta
authors.initials: E
authors.lastname: De Luca
authors.forename: Stefano
authors.initials: S
authors.lastname: D'Ugo
authors.forename: Valeria
authors.initials: V
authors.lastname: Tognoni
authors.forename: Ida
authors.initials: I
authors.lastname: Camperchioli
authors.forename: Domenico
authors.initials: D
authors.lastname: Benavoli
authors.forename: Nicola
authors.initials: N
authors.lastname: Di Lorenzo
authors.forename: Achille L
authors.initials: AL
authors.lastname: Gaspari
authors.forename: Paolo
authors.initials: P
authors.lastname: Gentileschi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D050110:Bariatric Surgery; D015992:Body Mass Index; D003248:Constipation / Q000453:epidemiology / Q000209:etiology*; D003672:Defecation; D005242:Fecal Incontinence / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy; D006801:Humans; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000150:complications* / Q000503:physiopathology / Q000601:surgery*; D015995:Prevalence; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D055815:Young Adult