Displaced dermal fat flaps for anal sphincter insufficiency

Bagaudinova SG, Kurbanova ZV, Istranov AL, et al. . Displaced dermal fat flaps for anal sphincter insufficiency. Plastic Surgery and Aesthetic Medicine. 2023;(2):32‑41. (In Russ., In Engl.)
https://doi.org/10.17116/plast.hirurgia202302132

Подписка 2026 Пластическая хирургия и эстетическая медицина (Plastic Surgery and Aesthetic Medicine)

Использование инфографики авторами научных работ

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OBJECTIVE

Searching for optimal highly effective surgical approach for anal sphincter insufficiency via anal ring autoplasty.

MATERIAL AND METHODS

The study enrolled 62 patients with anal sphincter insufficiency between 2004 and 2020 at the Russian Railways Hospital (Makhachkala). Inclusion criteria: complaints of intestinal incontinence and objective indicators of reduced pressure in anal canal Patients meeting selection criteria were divided into four groups: group 1 — patients with anal sphincter incontinence after correction of anorectal defects; group 2 — patients with anal sphincter incontinence after proctological surgery; group 3 — anal sphincter incontinence after childbirth; group 4 — patients with idiopathic anal sphincter incontinence. Correction of anal incontinence was performed original technique of displaced perianal dermal fat flaps.

RESULTS

Immediate results were evaluated after 3 weeks, long-term results — after 6 months and 1 year. We assessed the following criteria: patient satisfaction with treatment outcomes, overall improvement in the quality of life, postoperative complications, WIS score (0-20) and degree of anus gaping (complete absence of gaping).

CONCLUSION

Good immediate and long-term treatment outcomes were observed in 87.6% and 46.8% of cases, respectively. Important prognostic criteria are damage to anal sphincter and basal pressure in anal canal. Original correction of anal sphincter incontinence has a long-term effect and requires widespread implementation in clinical practice.

Keywords:

anal sphincter incontinence

autoplasty

dermal fat flaps

Authors:

Bagaudinova S.G.

Dagestan State Medical University

ORCID: 0000-0001-5574-5905

Kurbanova Z.V.

Dagestan State Medical University

ORCID: 0000-0002-2591-9895

Istranov A.L.

Sechenov First Moscow State Medical University

ORCID: 0000-0003-0222-2910

Omarova Kh.Z.

Dagestan State Medical University

ORCID: 0000-0003-1715-3567

Kurbanismailova M.G.

Dagestan State Medical University

ORCID: 0000-0002-6034-4388

Israpilov M.M.

Dagestan State Medical University

ORCID: 0000-0002-3270-3056

Abualrub N.A.

Dagestan State Medical University

ORCID: 0000-0003-1186-5395

Biyachueva L.A.

Sechenov First Moscow State Medical University (Sechenov University);
Pirogov Russian National Research Medical University

ORCID: 0000-0002-4368-9501

Received:

14.12.2022

Accepted:

27.12.2022

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References:

Vorobiev GI. Osnovy koloproktologii. Rostov-on-Don: Phoenix; 2001. (In Russ.).
Rivkin VL. Anal incontinence: the state of the problem. Consilium Medicum. Surgery (Suppl). 2016;1:24-25. (In Russ.).
Henry MM, Svash M, eds. Coloproctology and the Pelvic Floor. M.: Medicine; 1988:178-183, 256-308. (In Russ.).
Kaiser AM. Colorectal Surgery. M.: Binom; 2011:192-197. (In Russ.).
Menovshchikova LB, Kovarsky SL, Nikolaev SN, Sklyarova TA, Tekotov AN. Application of the new synthetic bulking material Vantris for the treatment of primary vesicoureteral reflux in children. Detskaya khirurgiya. 2012;4:12-15. (In Russ.).
Nedozimovanyi AI. Lechenie patsientov s inkontinentsiej kala metodov biologicheskoj obratnoj svyazi: Diss. ... kand. med. nauk. SPb; 2003:11-46. (In Russ.).
Lemperle G, Morhenn V, Charrier U. Human Histology and Persistence of Various Injectable Filler Substances for Soft Tissue Augmentation. Aesthetic Plastic Surgery. 2003;27:354-366.
Lentz GM. Anal Incontinence: Diagnosis and Management. In: General Gynecology. Part III. 2013:503-518.
Ratto C, Parello A, Donisi L, Litta F, De Simone V, Spazzafumo L, Giordano P. Novel bulking agent for faecal incontinence. British Journal of Surgery. 2011;98:1644-1652.
Ehrenpreis ED, Chang D, Eichenwald E. Pharmacotherapy for Fecal Incontinence: A Review. Disease of the Colon & Rectum. 2006;50:641-649.
Herold A. Aus Fettgewebe gezüchtete Stammzellen zur Behandlung komplexer perianaler Fisteln. Eine klinische Phase-II-Studie. Coloproctology. 2010;6(32):349. (In German).
Rintala RJ, Pakarien MP. Outcome of anorectalnmalformations and Hirschsprung’s diagnose beyond childhood. Seminars in Pediatric Surgery. 2010;19:160-167.
Meyer I, Richter HE. Impact of Fecal Incontinence and its treatment on quality of life in woman. Womens Health (Lond). 2015;11(2):225-238. PMID: 25776296; PMCID: PMC4394646. https://doi.org/10.2217/whe.14.66
Ormaechea M, Paladini M, Pisano R, Scagliotti M, Sambuelli R, Lopez S, Guidi A, Muñoz J, Rossetti V, Carnerero M, Beltramo D, Alasino R, Bianco I, Griguol O, Valladares D, De Badiola F. Vantris, a biocompatible, synthetic, non-biodegradable, easy-to-inject bulking substance. Evaluation of local tissullar reaction, localized migration and long-distance migration. Arch Esp Urol. 2008;2(61):263-268. https://doi.org/10.4321/s0004-06142008000200023
Papafragkakis H, Changela K, Bhatia T, Ona MA, Malieckal A, Paleti V, Fuksbrumer MS, Anand S. Endoscopic and imaging appearance after injection of an ano-rectal bulking agent. World Journal of Gastrointestinal Endoscopy. 2014;6(7):324-327.
Hussain ZI, Lim M, Stojkovic SG. Systematic review of perianal implants in the reatment of faecal incontinence. British Journal of Surgery. 2011;98:1526-1536.
Jongen J. Neuartiger „bulking agent“ bei Stuhlinkontinenz. Coloproctology. 2013;3:198-200. (In German).
Kenefick NJ, Vaizey CJ, Malouf AJ, Norton CS, Marshall M, Kamm MA. Injectable silicone biomaterial for faecal incontinence due to internal anal Sphincter dysfunction. Gut. 2002;51:354-366.
Davis K, Kumar D, Poloniecki J. Preliminary evaluation of an injectable anal sphincter bulking agent (Durasphere) in the management of faecal incontinence. Aliment Pharmacol Ther. 2003;18(2):237-243. https://doi.org/10.1046/j.1365-2036.2003.01668.x
Graft W, Mellgren A, Matzel KE, Hull T, Johansson C, Bernstein M. Efficacy of dextranomer in stabilized hyaluronic acid for treatment of faecal incontinence: A randomized, sham-controlled trial. The Lancet. 2011;377:997-1003.
Komissarov IA, Vasil’ev SV, Nedozimovannyi AI, Dement’eva EA. Experience of application of volume forming agent “DAM+” in treatment of anal incontinence associated with incompetence and trauma of anal sphincter. Grekov’s Bulletin of Surgery. 2016;5:79-82. (In Russ.).
Mashkov AE, Kulikov AV, Shumsky VI, Filyushkin UN, Kulikov DA, Slesarev VV, Pykhteev DA, Polyanskaya ZI, Ermilova EA, Rogatkin DA, Litvinova NS. Experience of anal insufficiency treatment using medullary transplantation in experiment and clinic. Almanakh klinicheskoj meditsiny. 2011; 25:13-16. (In Russ.).
Nurbekov AA. Posttravmaticheskaya analnaya inkontinentsiya: diagnostika, lechenie i profilaktika: Diss. ... d-ra med. nauk. Astana; 2009:3-40. (In Russ.).
Kulikovsky VF, Oleinik NV, Storozhilov DA, Naumov AV. Features of restoring normal anal holding. Coloproctology. 2015;1(51 Suppl):27. (In Russ.).
Vasiliev SV, Nedozimovanyi AI, Popov DE, Dementieva EA. The use of electrical stimulation in the treatment of anal incontinence. Proceedings of the All-Russian Congress of Coloproctologists with international participation “Operative and conservative coloproctology: modem technologies for a high quality of patient’s life” and the Joint Caspian and Baikal Forum on BD problems. 2016;2(56):20-21. (In Russ.).
De la Portilla F. Internal anal sphincter augmentation and substitution. Gastroenterol Rep (Oxf). 2014;2(2):106-111. PMID: 24759338; PMCID: PMC4020126. https://doi.org/10.1093/gastro/gou004
Ashbum JH, Hull TL. Rectal Prolapse. In: Fecal incontinence and Defecation Disorders. Part 6. Chapter 34. 2015;500-510.
Italian Society of Colorectal Surgery (SICCR); Pucciani F, Altomare DF, Dodi G, Falletto E, Frasson A, Giani I, Martellucci J, Naldini G, Piloni V, Sciaudone G; Italian Association of Hospital Gastroenterologists (AIGO); Bove A, Bocchini R, Bellini M, Alduini P, Battaglia E, Galeazzi F, Rossitti P, Usai Satta P. Diagnosis and treatment of fecal incontinence: Consensus statement of the Italian Society of Colorectal. Surgery and the Italian Association of Hospital Gastroenterologists. Digestive and Liver Disease. 2015; 47(8):628-645. https://doi.org/10.1016/j.dld.2015.03.028
Frolov SA, Titov AYu, Poletov NN, Kostarev IV, Fomenko OYu. Surgical treatment of patients with severe fecal incontinence. Pirogov Russian Journal of Surgery. 2014;4:27-33. (In Russ.).
Chittenden AS. Reconstruction of anal sphincter by muscle slips from glutei. Ann Surg. 1930;92:152-154.
Pickrell KL, Broadbent TR, Masters FW, Metzger JT. Construction of a rectal sphincter and restoration of anal continence by transplanting the gracilis muscle; a report of four cases in children. Ann Surg. 1952;135(6):853-862. PMID: 14924540; PMCID: PMC1802208. https://doi.org/10.1097/00000658-195206000-00010
Cavina E, Seccia M, Evangelista G, et al. Perineal colostomy and electrostimulated gracilis “neosphincter” after abdomino-perineal resection of the colon and anorectum: A surgical experience and follow-up study in 47 cases. Int J Colorectal Dis. 1990;5(1):6-11. https://doi.org/10.1007/BF00496141
Sato T, Konishi F, Ueda K, Kashiwagi H, Kanazawa K, Nagai H. Physiological anorectal reconstruction with pudendal nerve anastomosis and a colonic S-pouch after abdominoperineal resection: report of 2 successful cases. Surgery. 2000;128(1):116-120. https://doi.org/10.1067/msy.2000.107061
Milanov NO, Adamyan RT, Tsarkov PV, Istranov AL, Kravchenko AYu, Tulina IA. Sposob formirovaniya upravlyaemogo zamykatel’nogo apparata vokrug promezhnostnoj kolostomy pri utrate ili otsutstvii sfinkternogo apparata pryamoj kishki. Patent na izobretenie №2380047 MPK51 A61V 17/00. 29.09.2008/27.01.2010. Byull. №3. (In Russ.).