title: The use of Permacol® injections for the treatment of faecal incontinence.
abstract: The aim of this study is to assess the safety and efficacy of Permacol(®) implant for the treatment of idiopathic faecal incontinence using a novel injection technique. Patients with idiopathic passive faecal incontinence were selected for trans-submucosal injection of Permacol(®) after assessment by anorectal physiology and endoanal ultrasonography. Clinical assessment and St. Mark's Incontinence Score were used to evaluate efficacy before and at two time points (1 and 2 years) after treatment. Rockwood Score were also used to determine quality of life before and after treatment. The Friedman and Chi-square tests were used to compare continuous and categorical data, respectively. A p value of <0.05 was deemed significant. Thirty-eight patients (24 female), median age 66 years, were recruited. At maximum clinical follow-up (median of 9 months), response to Permacol(®) injections was categorised as excellent, good, fair and poor in 12, 5, 4 and 17 patients, respectively. St. Mark's Score improved in 72 and 63 % of patients at 1 and 2 years, respectively. However, a smaller proportion of patients (39 and 27 %, respectively) achieved a 50 %, or more, improvement in Mark's Score. All four domains of Rockwood Quality of Life Score improved on first and second year follow-up, however, only two domains, coping and embarrassment, were statistically significant. Permacol(®) injection improved symptoms by >50 % in 39 and 27 % of patients on short and medium-term follow-ups, respectively. The trans-submucosal technique for injection of Permacol(®) in this study was safe with no significant adverse outcomes.
authors.affiliation: Department of Colorectal Surgery, York Teaching Hospital, 1 Celtic Close, York, YO26 5QJ, UK. zeiadhussain@yahoo.com
authors.forename: Zeiad I
authors.initials: ZI
authors.lastname: Hussain
authors.forename: Michael
authors.initials: M
authors.lastname: Lim
authors.forename: Haider
authors.initials: H
authors.lastname: Mussa
authors.forename: Kazim
authors.initials: K
authors.lastname: Abbas
authors.forename: Stevan
authors.initials: S
authors.lastname: Stojkovic
mesh_terms: D000368:Aged; D001003:Anal Canal; D001672:Biocompatible Materials / Q000008:administration & dosage; D003094:Collagen / Q000008:administration & dosage*; D003672:Defecation; D019160:Endosonography; D005242:Fecal Incontinence / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007267:Injections; D007413:Intestinal Mucosa; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D019919:Prosthesis Implantation / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D001672:Biocompatible Materials; C422414:Permacol; D003094:Collagen