Incontinence after fistulotomy in low anal fistula: Can Kegel exercises help improve postoperative incontinence?-Reference-Cited by-同舟云学术

Incontinence after fistulotomy in low anal fistula: Can Kegel exercises help improve postoperative incontinence?

Published:2022-09-12 Issue:3 Volume:95 Page:13-20
ISSN:0032-373X
Container-title:Polish Journal of Surgery
language:
Short-container-title:Pol Przegl Chir

Author:

Garg Pankaj¹,Sohal Aalam²,Yagnik Vipul³,Kaur Baljit³,Menon Geetha⁴,Dawka Sushil⁵

Affiliation:

1. Indus Hospital, Mohali, India

2. Garg Fistula Research Institute, Panchkula, India

3. SSRD Imaging Centre, Chandigarh, India

4. Indian Council of Medical Research, New Delhi, India

5. SSR Medical College, Belle Rive, Mauritius

Abstract

Aim: Fistulotomy is the commonest procedure performed for low anal fistulas. The incidence of gas and urge incontinence after fistulotomy and whether Kegel exercises (KE) could help recover sphincter function after fistulotomy has not been studied before. Methods: Patients operated with fistulotomy for low fistulas were recommended KE (pelvic contraction exercises) 50 times/ day for one year postoperatively. Incontinence (solid, liquid, gas, and urge) was evaluated objectively (Vaizey’s scores) preoperatively [Pre-op Group], in the immediate postoperative period [Pre-KE Group], and at 6-month follow-up [Post-KE Group]. Incontinence scores in all three groups were compared to evaluate the efficacy of KE. Results: As many as 101 MRI-documented low anal fistula patients were included. There were 79 males (mean age 39.4 12.9 years) and the median follow-up was 12 months (6–18 months). Two patients were lost to follow-up. Fistulas healed in all the patients. Incontinence was present in 5/99 patients (mean incontinence scores –0.13 0.63) preoperatively and occurred in 20/99 (mean incontinence scores –1.03 2.18) patients postoperatively (Pre-KE Group). With KE, the incontinence improved completely in 10 and partially in another 10 (mean incontinence scores –0.31 1.09) patients. Urge and gas incontinence accounted for most cases (80%). The mean incontinence scores deteriorated significantly after fistulotomy (pre-op vs pre-KE, p = 0.000059, significant) but continence improved significantly with KE, thus the scores between pre-op and post-KE became comparable (pre-op vs post-KE, p = 0.07, not significant). Conclusions: Fistulotomy, even in low fistulas, can lead to a significant increase in gas and urge incontinence. Regular Kegel exercises postoperatively can help recover lost sphincter function and can bring back continence comparable to preoperative levels.

Publisher

Index Copernicus

Subject

General Medicine,Surgery

Link

https://ppch.pl/gicid/pdf/01.3001.0015.9820

Reference24 articles.

1. Litta F., Bracchitta S., Naldini G. et al.: FISSIT (Fistula Surgery in Italy) study:A retrospective survey on the surgical management of anal fistulas in Italy overthe last 15 years. Surgery, 2021; 170: 689–695.

2. Jayne D.G., Scholefield J., Tolan D. et al.: A Multicenter Randomized ControlledTrial Comparing Safety, Efficacy, and Cost-effectiveness of the Surgisis AnalFistula Plug Versus Surgeon’s Preference for Transsphincteric Fistula-in-Ano:The FIAT Trial. Ann Surg, 2021; 273: 433–441.

3. Dekker L., Zimmerman D.D.E., Smeenk R.M., Schouten R., Han-Geurts I.J.M.:Management of cryptoglandular fistula-in-ano among gastrointestinal surgeons in the Netherlands. Tech Coloproctol, 2021; 25(6): 709–719.

4. Litta F., Parello A., De Simone V. et al.: Fistulotomy and primary sphincteroplasty for anal fistula: long-term data on continence and patient satisfaction.Tech Coloproctol, 2019; 23: 993–1001.

5. Garg P.: Is fistulotomy still the gold standard in present era and is it highlyunderutilized?: An audit of 675 operated cases. Int J Surg, 2018; 56: 26–30.