tailieunhanh - Advanced Therapy in Gastroenterology and Liver Disease - part 7

báo cáo kết quả xuất sắc, trung bình là 2 năm, 73% bệnh nhân trước đó mất khả năng đạt được dục đầy đủ, các triệu chứng cải thiện rõ rệt cho những người khác. Không giống như các thủ tục neosphincter, SNS có liên quan đến bệnh suất tối thiểu. | Fecal Incontinence Evaluation and Treatment 515 FIGURE 88-2 Radiograph of an implanted sacral nerve stimulator device. Courtesy of Robert D. Madoff MD. recently reported excellent results at a median of 2 years 73 of previously incapacitated patients achieved full continence symptoms markedly improved for the others. Unlike the neosphincter procedures SNS has been associated with minimal morbidity. This fact suggests that indications for the procedure might reasonably be broadened at least on an investigational basis in the future. Radiofrequency Energy Delivery Submucosal radiofrequency energy delivery to the anal canal also known as the Secca procedure is a thermal technique currently under investigation in a multicenter trial. The procedure consists of anal insertion of a heat-controlled probe. The probe then deploys electrodes that pierce the mucosa and heat the muscularis resulting in collagen contraction. However the exact mechanism of action using this technique is unknown. Early results have shown modest improvement in incontinence severity. Anal Canal Bulking and Obstructing Agents In contrast to stool bulking agents anal canal bulking agents are made of implanted natural or synthetic materials such as collagen silicone or carbon coated beads that are injected into the intersphincteric space to bolster function of the internal anal sphincter. We do not perform this procedure although good outcomes in very small series have been reported. Obstructing agents such as pliable rubber balloons are placed in the anus they can be removed by the patient for controlled defecation Norton and Kamm 2001 Mortensen and Humphreys 1991 . Such an intervention might be useful for patients who are at very poor risk for surgery. Stoma For patients with refractory incontinence a properly placed and well-constructed stoma offers restoration of bowel control if not true continence with minimal associated morbidity. Although the presence of a stoma admittedly distorts an .

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