[Treatment of anal fistulas].
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Drainage↗
Biomedical subjects
John Christiansen
Publications and source records attributed to John Christiansen.
[Sacral nerve stimulation in fecal incontinence].
INTRODUCTION: Sacral nerve stimulation for the treatment of faecal incontinence has gained increasing use in Europe over the last two years. Experience with the first patients treated in Denmark is described here. MATERIAL AND METHODS: Fourteen patients with severe faecal incontinence were given sacral nerve stimulation. The first treatment was temporary, and if this was successful they had a device for permanent stimulation implanted. RESULTS: The result of the test stimulation was good in ten of the 14 patients and a permanent system was implanted. After a median of 4.5 months' stimulation, nine of the ten patients continued to respond to respond well. DISCUSSION: Sacral nerve stimulation in the treatment of faecal incontinence shows promising results. Compared to other more advanced forms of treatment, this method is minimally invasive.
Adult↗
[Fecal incontinence].
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Fecal Incontinence↗
[Chronic idiopathic anal pain syndrome].
INTRODUCTION: The study was undertaken to analyse whether intra-anal ultrasound examination, anorectal physiological evaluation, and histopathological examination of patients suffering from chronic idiopathic anal pain presented any common features and to analyse the results of various treatments. MATERIAL AND METHODS: Eighteen patients who met the criteria for chronic idiopathic anal pain were studied. Treatment included 0.2% glyceryl nitrate ointment, ultrasound guided injection of botulinum toxin in the intrasphincteric space, analgesics, and colostomy. RESULTS: Anal physiological examinations were normal in all but one patient. Intra-anal ultrasonography demonstrated abnormalities in 12 patients. Defecography showed in one patient a small distal invagination but was otherwise normal. Glyceryl nitrate ointment had an effect in one of four patients, and botulinum toxin in four of nine. Two patients needed a colostomy for definitive pain relief, and in 12 of the 18 patients the final treatment was analgesics. DISCUSSION: The methods used in this study did not contribute to the understanding of the pathogenesis of chronic anal pain. The treatment is experimental, but injection of botulinum toxin may be tried on the hypothesis that dystonia in the anal sphincter may play a pathogenetic role.
Adult↗
Long-term efficacy of dynamic graciloplasty for fecal incontinence.
PURPOSE: Patients with end-stage fecal incontinence in whom all standard medical and surgical treatment has failed or is not expected to be effective can be treated by dynamic graciloplasty. The aim of this study was to review the long-term efficacy data. METHODS: Success was defined as a greater than 50 percent decrease in the frequency of incontinent episodes. Measured physiologic parameters included enema retention time and the difference in resting and squeezing pressures with and without stimulation. Measured quality-of-life parameters included the Medical Outcomes Study Short Form 36 Health Status Questionnaire, a Fecal Incontinence TyPE Specification, the Zung Self-Rating Depression Scale, the "state" portion of the State-Trait Anxiety Inventory, and the Visual Analog Scale, which were administered at baseline and through follow-up. Independent monitors collected data as part of a multicenter trial for patients who underwent dynamic graciloplasty from May 1993 to November 1999. RESULTS: There were 129 patients entered in the study, 115 of whom met eligibility criteria and were included in the efficacy outcome analysis. Twenty-seven patients entered the study with a preexisting functioning stoma; the remaining 88 patients did not have a functioning stoma at the time of enrollment. Success was achieved in 62 percent of nonstoma patients at 12 months; these results were sustained at 18-month and 24-month follow-up assessments (55 and 56 percent, respectively). The success rate in the stoma patients increased from 37.5 percent (9 of 24 patients) at 12 months to 62 percent (13 of 21 patients) at 18 months and was 43 percent at 24 months (9 of 21 patients), which reflects the increased number of patients whose stomas were closed. Although the measured physiologic continence parameters generally improved, these changes did not correlate with continence outcome. The group of patients (stoma and nonstoma) who underwent dynamic graciloplasty showed statistically significant improvements in quality of life as measured by Medical Outcomes Study Short Form 36 physical function (P = 0.006) and social functioning (P = 0.02) assessment. CONCLUSIONS: Dynamic graciloplasty was successful in the majority of patients with end-stage fecal incontinence. This result was usually achieved by 12 months after surgery in patients who did not have stomas and by 18 months in patients who had stomas at the time of dynamic graciloplasty surgery. These various improvements conferred by dynamic graciloplasty persisted during the two-year follow-up.
Adolescent↗