Efficacy of Kegel exercises in preventing incontinence after partial division of internal anal sphincter during anal fistula surgery  

作　　者：Pankaj Garg Vipul D Yagnik Baljit Kaur Geetha R Menon Sushil Dawka 

机构地区：[1]Department of Colorectal Surgery,Garg Fistula Research Institute,Panchkula 134113,Haryana,India [2]Department of Colorectal Surgery,Indus International Hospital,Mohali 140507,Punjab,India [3]Department of Surgical Gastroenterology,Nishtha Surgical Hospital and Research Center,Patan 384265,Gujarat,India [4]Department of Radiology,SSRD Magnetic Resonance Imaging Institute,Chandigarh 160011,India [5]Department of Statistics,Indian Council of Medical Research,New Delhi 110029,India [6]Department of Surgery,SSR Medical College,Belle Rive 744101,Mauritius

出　　处：《World Journal of Clinical Cases》2022年第20期6845-6854,共10页世界临床病例杂志

摘　　要：BACKGROUND The transanal opening of intersphincteric space(TROPIS)procedure,performed to treat complex anal fistulas,preserves the external anal sphincter(EAS)but involves partial incision of the internal anal sphincter(IAS).AIM To ascertain the incidence of incontinence after the division of the IAS as is done in TROPIS and to evaluate whether regular Kegel exercises(KE)in the postoperative period can prevent incontinence due to IAS division.METHODS Patients operated on for high complex fistulas and having no preoperative continence problem(score=0)were included in the study.All patients were operated on by the TROPIS procedure and were recommended KE(pelvic contraction exercises)50 times/day.KE were commenced on the 10^(th)postoperative day and continued for 1 year.Incontinence was evaluated objectively(by modified Vaizey’s scores)in the immediate postoperative period(Pre-KE group)and on long-term follow-up(Post-KE group).The incontinence scores in both groups were compared to evaluate the efficacy of KE.RESULTS Of 102 anal fistula patients operated on between July 2018 and July 2020 were included in this study.There were 90 males,the mean age was 42.3±12.8,and the median follow-up was 30 mo(18-42 mo).Three patients were lost to follow-up.There were 65 recurrent fistulas,92 had multiple tracts,42 had associated abscess,46 had horseshoe fistula and 34 were supralevator fistulas.All were magnetic resonance imaging-documented high fistulas(>1/3 EAS involved).Overall incontinence occurred in 31%patients(Pre-KE group)with urge and gas incontinence accounting for the majority of cases(28.3%).The mean incontinence scores in the Pre-KE group were 1.19±1.96(in 31 patients,solid=0,liquid=7,gas=8,urge=24)and in the Post-KE group were 0.26±0.77(in 13 patients,solid=0,liquid=2,gas=3,urge=10)(P=0.00001,t-test).CONCLUSION Division of the IAS led to incontinence,mainly urge incontinence,and also to a mild degree of gas and liquid incontinence.However,regular KE led to a significant reduction in incontinence(both in the nu

关 键 词：Anal fistula INCONTINENCE URGE Transanal opening of intersphincteric space Kegel exercises MANOMETRY 

分 类 号：R657.16[医药卫生—外科学]