The Functional Luminal Imaging Probe (FLIP): A Good Tool for Adjustment of anal Canal Dimensions During Operative Management of Fecal Incontinence

Abstract

Purpose

Fecal incontinence is a troublesome problem in the field of colorectal surgery. The main aim of this study was to adjust the anal canal resistance during operative management of anal incontinence using Endo-FLIP.

Methods

This was a prospective cohort study held at Cairo university hospital. Hundred forty-eight incontinent patients treated by different surgical procedures were included. During the procedure the Endo-FLIP was applied to adjust the anal canal dimensions (ACL and ACD) so the ACR could be adjusted based on the flow equation. These were also assessed pre-operatively with Endo-FLIP system and the flow equation calculator. The clinical severity of the disease and outcome after surgical procedures were assessed and correlated to the physiologic parameters.

Results

ACL, ACD and ACR had had significant correlations to the degree of incontinence (P < .001). ACL, ACD and ACR showed statistically significant change with primary repair and gluteus maximus transposition operations. After treatment of fecal incontinence, in good responders’ group, the mean resting anal canal resistance increased significantly to 4649.05 ± 1161.49 (postoperative) while in poor responders’ group it was 1919.9 ± 1077.73.

Conclusions

The Endo-flip can be used to measure the anal canal geometric parameters (ACL and ACD) and then anal canal resistance could be calculated by the flow equation – pre-and post-operatively- which help the adjustment of the surgical repair of sphincter injury in fecal incontinence patients which may improve the surgical outcome.

Keywords

anal canal length anal canal diameter anal canal resistance endo-FLIP flow equation faecal incontinence and gluteus maximus flap

Get full access to this article

View all access options for this article.

References

Rao

SSC

. Pathophysiology of adult fecal incontinence. Gastroenterology. 2004;126:14-22.

Harris

Pope

II . Squeeze vs. resistance: An evaluation of the mechanism of sphincter competence. J Clin Invest. 1964;43:2272-2278.

Harris

Winans

Pope

II . Determination of yield pressures: A method for measuring anal sphincter competence. Gastroenterology. 1966;50:754-760.

Katz

Kaufmann

Spiro

. Anal sphincter pressure characteristics. Gastroenterology. 1967;52:513-518.

Liberman

. Objective measurement of external anal Sphincter tension. Am J Proctol. 1964;15:375-381.

Farag

. Use of the hagen-poiseuille law: A new mathematical approach for the integration and evaluation of anorectal physiological testing in patients with faecal incontinence and pelvic dyschezia and in normal controls. Eur Surg Res. 1998;30(4):279-289.

Farag

. The use of flow equation in functional coloproctology: A new theory in anorectal physiology. Pelviperineology. 2009;28:17-23.

Farag

. Integrated Coloproctology. Germany: lamberet academic publishing; 2012;5:63-70.

McMahon

Frøkjaer

Liao

Kunwald

Drewes

Gregersen

. A new technique for evaluating sphincter function in visceral organs: Application of the functional lumen imaging probe (FLIP) for the evaluation of the oesophago-gastric junction. Physiol Meas. 2005;26:823-836.

10.

Fynne

Luft

Gregersen

, et al. Distensibility of the anal canal in patients with systemic sclerosis: A study with the functional lumen imaging probe. Colorectal Dis. 2013;15:40-47.

11.

Lottrup

Gregersen

Liao

, et al. Functional lumen imaging of the gastrointestinal tract. J Gastroenterol. 2015;50:1005-1016.

12.

Soerensen

Liao

Lundby

. Distensibility of the anal canal in patients with idiopathic fecal incontinence a study with the functional luminal imaging probe. Nuerogastroenterol Motil. 2014;26:255-263.

13.

Jorge

JMN

Wexner

. Etiology and management of fecal incontinence. Dis Colon Rectum. 1993;36:77-97.

14.

Halverson

Hull

. Long-term outcome of overlapping anal sphincter repair. Dis Colon Rectum. 2002;45(3):345-348.

15.

Pearl

Prasad

Nelson

Orsay

Abcarian

. Bilateral gluteus maximus transposition for anal incontinence. Dis Colon Rectum. 1991;34:478-481.

16.

Chan

. Biostatistics102: Quantitative data – Parametric and non-parametric tests. Singapore Med J. 2003;44(8):391-396.

17.

Chan

. Biostatistics 103: Qualitative data –Tests of independence. Singapore Med J. 2003;44(10):498-503.

18.

Chan

. Biostatistics 104: Correlational analysis. Singapore Med J. 2003c;44(12):614-619.

19.

Massey

. Mechanics of Fluids. London: London LBS/Chapman and Hall; 1989.

20.

Douglas

Gasirek

Sawffield

. Fluid Mechanics. Harlow: LBS/Longman; 1995.

21.

McMahon

Frøkjær

Kunwald

, et al. The functional lumen imaging probe (FLIP) for evaluation of the esophagogastric junction. Am J Physiol Gastrointest Liver Physiol. 2007;292:377-384.

22.

Fynne

Luft

Gregersen

, et al. Distensibility of the anal canal in patients with systemic sclerosis: A study with the functional lumen imaging probe. Colorectal Dis. 2013;15:40-47.

23.

Lottrup

GregersenLiao

Fynne

, et al. Functional lumen imaging of the gastrointestinal tract. J Gastroenterol. 2015;50:1005-1016.

24.

Ngamruengphong

von Rahden

BHA

Filser

, et al. Intraoperative measurement of esophagogastric junction cross-sectional area by impedance planimetry correlates with clinical outcomes of peroral endoscopic myotomy for achalasia: A multicenter study. Surg Endosc. 2016;30(7):2886-2894.

25.

Farag

O’Dea

. Intra-operative use of impedance planimetry during surgery for fecal incontinence. Gastroenterology. 2015;148(4):S827-S827.

26.

Reginelli

Mandato

Cavaliere

, et al. Three-dimensional anal endosonography in depicting anal-canal anatomy. Radiol Med. 2012;117(5):759-771.

27.

Fenner

Kriegshauser

Lee

, et al. Anatomic and physiologic measurements of the internal and external anal sphincters in normal females. Obstet Gynecol. 1998;91(3):369-374. ‏.

28.

Shorvon

McHugh

Diamant

Somers

Stevenson

. Defecography in normal volunteers: Results and implications. Gut. 1989;30(12):1737-1749.

29.

Saldana Ruiz

Kaiser

. Fecal incontinence-challenges and solutions. World J Gastroenterol. 2017;23(1):11-24.

30.

Zutshi

Salcedo

Hammel

Hull

. Anal physiology testing in fecal incontinence: Is it of any value. Int J Colorectal Dis. 2010;25:277-282.

31.

Farid

Farag

. The use of unilateral gluteus maximus muscle for the management of fecal incontinence following anorectal surgery. Tech Coloproctol. 2000;4(1):7-12. ‏.

32.

Farid

Moneim

Mahdy

Omar

. Augmented unilateral gluteoplasty with fascia lata graft in fecal incontinence. Tech Coloproctol. 2003;7(1):23-28.