anatomy or physiology.pdf

Pelvic Floor Procedures Produce No Consistent Changes in Anatomy or Physiology W. F. van Tets, M.D., Ph.D.,* J. H. C. Kuijpers, M.D., Ph.D.t From the Departments of Surgery, *Lukas-Andreas Hospital, Amsterdam, The Netherlands, and t University Hospital Nijmegen, Nijmegen, The Netherlands PURPOSE: Postanal repair was designed to restore both anatomy and function of the anal canal in neurogenic fecal incontinence. In most series, the degree of continence is improved in fewer than 50 percent of patients. Adding anterior levatorplasty and sphincter plication (total pelvic floor repair) is claimed to improve functional results. We performed a randomized trial comparing postanal and total pelvic floor repair for neurogenic incontinence. METHOD: Twenty female patients were studied. All had Type D in- continence (Parks and Browning). Anal manometry, de- fecography, and grading of the degree of continence were repeated 12 weeks after surgery to assess changes in clini- cal, manometric, and radiologic parameters. Statistical anal- ysis was done using Wilcoxons signed-rank test and Wilc- oxons two-sample test. RESULTS: Continence improved in eight patients. Differences among clinical, manometric, and radiologic data were not statistically significant. CONCLU- SION: Pelvic floor repair procedures produce no consistent changes in anatomy or physiology. Clinical improvement is caused by creation of a local stenosis or by the placebo effect rather than by improvement of muscle function. [Key words: Postanal repair; Total pelvic floor repair; Anal ma- nometry; Defecography] van Tets W-F, Kuijpers JHC. Pelvic floor procedures produce no consistent changes in anatomy or physiology. Dis Colon Rectum 1998;41:365-369. N eurogenic fecal incontinence is associated with a deficient anorectal angle and weak function- ing of the external anal sphincter. Postanal repair was designed to improve the acute anorectal angle and to restore functional anal canal