title: Perineal antropylorus transposition for end-stage fecal incontinence in humans:  initial outcomes.
abstract: BACKGROUND
  Technical feasibility of perineal antropyloric valve transposition to reconstruct a severely damaged incontinent anal sphincter or to replace an excised anorectal sphincter has been reported previously.
  
  
  OBJECTIVE
  This study aimed to document the follow-up results of patients who underwent successful perineal antropyloric valve transposition for end-stage fecal incontinence.
  
  
  METHODS
  This study was conducted at a single tertiary care institution.
  
  
  METHODS
  Seventeen patients underwent the procedure. Eight patients had replacement (group 1) and 9 patients had augmentation (group 2) of the anal sphincter. Two patients in group 1 with early graft-related complications were excluded from further analysis, because they had the grafts excised.
  
  
  METHODS
  The primary outcome measures were anatomical integrity and functional status of the graft in the perineum, fecal incontinence scores, and quality-of-life scores (SF-36) over a median follow-up of 18 months.
  
  
  RESULTS
  The transposed grafts had a definite tone on digital examination, were well visualized on perineal MRI, showed high-velocity vascular inflow on Doppler ultrasound study, and good vascularity on celiac CT angiography. Anal manometry showed a significant (p = 0.03) rise in the postoperative resting neosphincter pressures with good retention of barium proximal to pyloric valve on distal loopogram. The postoperative St Mark incontinence score improved in both groups and was significantly better in group 2 than in group 1. There was significant improvement in postoperative physical and mental component scores in both groups with higher scores in group 2 than in group 1 on follow-up.
  
  
  CONCLUSIONS
  A longer follow-up with a larger sample size is required.
  
  
  CONCLUSIONS
  Antropyloric valve transposition can be used effectively for a selected group of patients with end-stage fecal incontinence. Patients undergoing anal sphincter augmentation have better outcomes in comparison with those having an excised sensate anorectum.
authors: Department of Surgical Gastroenterology, King George's Medical University, Lucknow, India. abhijitchandra@hotmail.com
authors: Abhijit
authors: A
authors: Chandra
authors: Ashok
authors: A
authors: Kumar
authors: M
authors: M
authors: Noushif
authors: Vishal
authors: V
authors: Gupta
authors: Devendra
authors: D
authors: Singh
authors: Manoj
authors: M
authors: Kumar
authors: R N
authors: RN
authors: Srivastava
authors: U C
authors: UC
authors: Ghoshal
mesh_terms: D000293:Adolescent; D000328:Adult; D001003:Anal Canal / Q000503:physiopathology / Q000601:surgery*; D002648:Child; D005242:Fecal Incontinence / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010502:Perineum / Q000601:surgery*; D011788:Quality of Life; D019651:Plastic Surgery Procedures / Q000379:methods*; D016896:Treatment Outcome; D055815:Young Adult