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Quality of Life After Surgery for Colon Cancer in Patients With Lynch Syndrome: Partial Versus Subtotal Colectomy
BACKGROUND: Lynch syndrome is a disorder caused by mismatch repair gene mutations. Mutation carriers have a high risk of developing colorectal cancer. In patients with Lynch syndrome in whom colon cancer has been diagnosed, in general, subtotal colectomy instead of partial colectomy is recommended because of the substantial risk of metachronous colorectal cancer. However, the effect of more extensive surgery on quality of life and functional outcome is unknown.
OBJECTIVE: The aim of this study was to investigate quality of life and functional outcome in patients with Lynch syndrome after partial colectomy and subtotal colectomy.
DESIGN: This is a nationwide cross-sectional study in the Netherlands.
SETTINGS: Two quality-of-life questionnaires (Short Form-36 and The European Organization for Research and Treatment of Cancer Colorectal Cancer-specific Quality of Life Questionnaire Module) and a functional outcome questionnaire (Colorectal Functional Outcome) were used.
PATIENTS: Patients with Lynch syndrome who underwent surgery for colon cancer were included.
MAIN OUTCOME MEASURES: The primary outcomes measured were quality of life and functional outcome.
RESULTS: Questionnaires were sent to 192 patients with Lynch syndrome who underwent surgery for colorectal cancer. A total of 136 patients returned the questionnaire (response rate, 71%). Eighteen patients with rectal cancer, 9 patients with a permanent ileostomy, and 5 patients with an IPAA were excluded. Fifty-one patients underwent partial colectomy, and 53 underwent subtotal colectomy. None of the scales of the Short Form-36 survey showed a significant difference. Analysis of the Colorectal Functional Outcome questionnaire revealed that, after subtotal colectomy, patients have a significantly higher stool frequency (p ≤ 0.01) and a significantly higher score on stool-related aspects (p = 0.06) and social impact (p = 0.03). The European Organization for Research and Treatment of Cancer Colorectal Cancer-specific Quality of Life Questionnaire Module presented more problems with defecation after subtotal colectomy (p ≤ 0.01).
LIMITATIONS: Certain selection bias cannot be ruled out.
CONCLUSIONS: Although functional outcome is worse after subtotal colectomy than after partial colectomy, generic quality of life does not differ after the 2 types of surgery in Lynch syndrome. When discussing the options for surgery with the patient, all advantages and disadvantages of both surgical procedures, including quality of life and functional outcome, should be discussed.
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Canadian Association of General Surgeons, the American College of Surgeons, the Canadian Society of Colorectal Surgeons, and the American Society of Colorectal Surgeons Evidence Based Reviews in Surgery – Colorectal Surgery
No abstract available
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High-Throughput Arrays Identify Distinct Genetic Profiles Associated With Lymph Node Involvement in Rectal Cancer
BACKGROUND: Preoperative clinical diagnosis of lymph node involvement guides treatment decisions for rectal cancer. Unfortunately, clinical staging still suffers from a lack of accuracy.
OBJECTIVE: The aim of this study was to evaluate objective genetic differences in primary rectal cancers with and without associated lymph node metastasis.
DESIGN: cDNA microarrays were generated from fresh-frozen tumors. Normalized data underwent global unsupervised hierarchical clustering analysis, and discriminating genes were mapped. Top discriminating genes were compared between stage II and III rectal cancers by use of an empirical Bayes 2 group t test with the Statistical Analysis of Microarrays and the Reproducibility-Optimized Test Statistic software separately to guide data reduction and deal with the difficulties of simultaneous statistical inference. Ingenuity Pathways Analysis software was used to analyze discriminating genes in terms of function and biological processes.
PATIENTS: Fifty-five patients with stage II and 22 patients with stage III rectal adenocarcinomas not treated with chemoradiation were included.
RESULTS: Two major unsupervised clusters emerged representing stage II and III cancers. In 1 cluster, 11 of 12 patients (92%) had stage III cancer; in the other cluster, 54 of 65 patients (83%) had stage II (p < 0.001). Five significantly differentially expressed genes characterized the stage III cluster: interleukin-8, 3-hydroxy-3-methylglutaryl coenzyme A synthase, carbonic anhydrase, ubiquitin, and cystatin (all p < 0.05). Of the 12 patients with differential expression of the 5 marker genes, only one had stage II cancer. Fifty-four of 55 stage II patients clustered with alternative expression patterns of the predictor genes. Differentially expressed genes are related to cancer-associated processes, pathways, and networks.
LIMITATIONS: The identified gene signatures have not yet been validated in independent patient populations.
CONCLUSIONS: Distinct gene expression signatures from primary rectal adenocarcinomas can help differentiate the presence or absence of lymph node metastases. These data are informative, and validation of this gene signature may provide a novel approach for more appropriate individualized treatment selection.
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Percutaneous Tibial Nerve Stimulation for Fecal Incontinence: A Video Demonstration
BACKGROUND: Fecal incontinence is an increasingly common condition with significant negative impact on quality on life and health care resources. It frequently presents a therapeutic challenge to clinicians. Emerging evidence suggests that percutaneous tibial nerve stimulation is an effective treatment for fecal incontinence with the added benefit of being minimally invasive and cost effective.
METHOD: Pursuant to the preliminary report of our early experience of percutaneous tibial nerve stimulation in patients with fecal incontinence published in this journal in 2010, in this dynamic article, we now describe and demonstrate the actual technique that can be performed in a nurse-led clinic or outpatient or community setting.
CONCLUSION: Percutaneous tibial nerve stimulation is a technically simple procedure that can potentially be performed in an outpatient or community setting. The overall early success rate of 68% following its use reported by our unit compares favorably with the success rate following other forms of neuromodulation, including sacral nerve stimulation. When completed, our long-term outcome data will provide further information on the efficacy of tibial nerve stimulation in a larger cohort of patients (n > 100). Future studies, including our currently planned randomized controlled trial of percutaneous tibial nerve stimulation vs sham stimulation, will provide controlled efficacy data and may provide information on its exact mechanism of action.
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The Incidence and Risk Factors of Metachronous Colorectal Cancer: An Indication for Follow-up
BACKGROUND: Patients with colorectal cancer are at risk for developing metachronous colorectal cancer. The purpose of posttreatment surveillance is to detect and remove premalignant lesions to prevent metachronous colorectal cancer.
OBJECTIVE: The aim of this study was to investigate the incidence of and predictive factors for metachronous colorectal cancer in patients with newly diagnosed colorectal cancer.
DESIGN AND PATIENTS: The data on all patients with newly diagnosed colorectal cancer between 1995 and 2006 were obtained from the Rotterdam Cancer Registry in The Netherlands and studied for metachronous colorectal cancer.
MAIN OUTCOME MEASURES: The annual incidence rate and the standardized incidence ratios were calculated.
RESULTS: In total, colorectal cancer was diagnosed in 10,283 patients; there were 39,974 person-years of follow-up. The mean annual incidence rate of metachronous colorectal cancer was 314/100,000 person-years at risk during 10 years of follow-up, corresponding with a mean annual incidence of 0.3% and a cumulative incidence of 1.1% at 3 years, 2.0% at 6 years, and 3.1% at 10 years. The incidence of metachronous colorectal cancer after resection of a first colorectal cancer is significantly higher than the incidence of colorectal cancer in an age- and sex-matched general population (standardized incidence ratio 1.3, 95% CI 1.1–1.5). This difference is especially seen during the first 3 years after first colorectal cancer diagnosis (standardized incidence ratio 1.4, 95% CI 1.1–1.8). The presence of synchronous colorectal cancer was the only significant risk factor for developing metachronous colorectal cancer (relative risk 13.9, 95% CI 4.7–41.0).
CONCLUSIONS: Despite the availability of colonoscopy, metachronous colorectal cancer is still seen during follow-up in patients with colorectal cancer; the highest risk is during the first 3 years after initial diagnosis. For this reason, a follow-up colonoscopy is useful at a short-term interval after colorectal cancer diagnosis. The presence of synchronous colorectal cancer at the time of first colorectal cancer diagnosis is the only predictive risk factor for developing metachronous colorectal cancer. Tailored surveillance programs may be considered in patients with a diagnosis of synchronous tumors.
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Does Preoperative Immunosuppression Influence Unplanned Hospital Readmission After Surgery in Patients With Crohn’s Disease?
BACKGROUND: Steroids, immunomodulators, and biologics, often in combination with one another, are frequently used in the treatment of Crohn’s disease. Retrospective studies have yielded conflicting results regarding the influence of preoperative immunosuppressive therapy on postoperative complications after surgery in Crohn’s disease. Unplanned hospital readmission is considered to be an index of quality surgical care.
OBJECTIVE: The aim of this study was to examine the association, if any, between the number of preoperative immunosuppressive therapies and unplanned hospital readmission after surgery in patients with Crohn’s disease.
DESIGN: Consecutive patients with Crohn’s disease requiring abdominal surgery were identified from a prospectively maintained database. Preoperative immunosuppressive therapy within 3 months before surgery was categorized into 3 classes: steroids, immunomodulators, and biologics.
MAIN OUTCOME MEASURES: Unplanned readmission occurring within 30 days of hospital discharge was assessed. Trend analysis was performed with the use of the Cochrane-Armitage test.
RESULTS: The study group included 338 patients. Preoperative medical therapy included steroids (n = 199; 59%), immunomodulators (n = 162; 48%), and biologics (n = 59; 18%). Sixty-three patients (19%) were not treated with any immunosuppressive medications preoperatively, whereas 148 patients (44%), 108 patients (32%), and 19 patients (6%) were treated with 1, 2, or 3 classes of immunosuppressive medications. Twenty-eight patients (8.3%) had an unplanned readmission. The incidence of unplanned readmission was similar among patients treated with steroids (11%), immunomodulators (9%), and biologics (12%). The incidence of unplanned readmission was 3%, 7%, 11%, and 16% in patients treated with 0, 1, 2, or 3 preoperative medication classes (trend analysis p = 0.02). No significant differences were observed between patient groups treated with 0, 1, 2, or 3 preoperative immunosuppressive therapies with respect to patient, disease, or surgical factors.
CONCLUSIONS: Unplanned hospital readmission occurs frequently (8.3%) after surgery for Crohn’s disease. Combination immunosuppressive therapy before surgery in patients with Crohn’s disease appears to be associated with an increased incidence of postoperative unplanned hospital readmission.
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Laparoscopy…For All?
No abstract available
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High Tie Versus Low Tie Vascular Ligation of the Inferior Mesenteric Artery in Colorectal Cancer Surgery: Impact on the Gain in Colon Length and Implications on the Feasibility of Anastomoses
BACKGROUND: There is no demonstrated benefit of high-tie versus low-tie vascular transections in colorectal cancer surgery.
OBJECTIVE: The aim of this study was to compare the effects of high-tie and low-tie vascular transections on colonic length after oncological sigmoidectomy, the theoretical feasibility of colorectal anastomosis at the sacral promontory, and straight or J-pouch coloanal anastomosis after rectal cancer surgery with total mesorectal excision.
DESIGN: This study is an anatomical study on surgical techniques.
SETTINGS: This study was conducted in a surgical anatomy research unit.
PATIENTS: Thirty fresh nonembalmed cadavers were randomly assigned to high-tie and low-tie groups (n = 15).
INTERVENTIONS: Oncological sigmoidectomy followed by total mesorectal excision was performed.
MAIN OUTCOME MEASURES: The distances from the proximal colon limb to the lower edge of the pubis symphysis were recorded after each step of vascular division.
RESULTS: The successive mean gains in length in high-tie vs low-tie vascular transections were 2.9±1.2 cm vs 3.1 ± 1.8 cm (p = 0.83) after inferior mesenteric artery division, 8.1 ± 3.1 cm vs 2.5 ± 1.2 cm (p = 0.0016) after inferior mesenteric vein division at the lower part of the pancreas, 8.1 ± 3.8 cm vs 3.3 ± 1.7 cm (p = 0.0016) after sigmoidectomy. The mean cumulative gain in length was significantly higher in high-tie vs low-tie vascular transections (19.1 ± 3.8 vs 8.8 ± 2.9 cm, p = 0.00089). After secondary left colic artery division, the gain in length was similar to that of the high-tie group (17 ± 3.1 vs 19.1 ± 3.8 cm) (p = 0.089). Colorectal anastomosis at the promontory and straight and J-pouch coloanal anastomosis feasibility rates were 100% in the high-tie group, 87%, 53%, and 33% in the low-tie group, but 100%, 100%, and 87% after secondary left colic artery division.
LIMITATIONS: This anatomical study, based on cadavers rather than live patients, does not evaluate colon limb vascularization.
CONCLUSIONS: The gain in colonic length is 10 cm greater for high-tie vascular transections. With low-tie vascular transections, high inferior mesenteric vein division produced a small additional gain in length, and secondary left colic artery division produced the same length gain as high-tie vascular transections.
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Sacral Nerve Stimulation for Fecal Incontinence: At a Crossroad and Future Challenges
No abstract available
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A Meta-analysis of the Effectiveness of the Opioid Receptor Antagonist Alvimopan in Reducing Hospital Length of Stay and Time to GI Recovery in Patients Enrolled in a Standardized Accelerated Recovery Program After Abdominal Surgery
BACKGROUND: Despite accelerated recovery programs and the widespread uptake of laparoscopic surgery, postoperative ileus remains a significant factor affecting length of stay after abdominal surgery. Alvimopan, an opioid-receptor antagonist, may reduce the incidence of postoperative ileus and expedite hospital discharge.
OBJECTIVE: The aim of this study was to perform a meta-analysis to determine the role of alvimopan in accelerating GI recovery and hospital discharge after laparoscopic and open abdominal surgery performed within an accelerated recovery program.
DATA SOURCES AND STUDY SELECTION: Cochrane (1999–2010), Embase (1980–2010), MEDLINE (1980–2010), and International Pharmaceutical Abstracts (1970–2010) were searched for relevant double-blinded, randomized controlled trials.
INTERVENTIONS: Twelve milligrams of alvimopan and placebo were given to patients enrolled in an accelerated recovery program after abdominal surgery.
MAIN OUTCOME MEASURES: The primary outcomes measured were the length of stay as defined by the writing of the hospital discharge order and GI-3 and GI-2 GI tract recovery.
RESULTS: Three trials were included that reported on a pooled modified intention-to-treat population of 1388 patients; 685 (49%) patients received alvimopan. On meta-analysis, alvimopan reduced time to the hospital discharge order (HR 1.37 (1.21, 1.62), p < 0.0001), GI-3 recovery (HR 1.42 (1.25, 1.62), p < 0.001), and GI-2 recovery (HR 1.49 (1.32, 1.68), p < 0.0001).
LIMITATIONS: The search criteria identified only a small number of trials of alvimopan after abdominal surgery with no randomized trials of alvimopan after laparoscopic surgery. In addition, the use of length of hospital stay as the primary outcome measure may be inappropriate, because it is open to many confounding factors. Finally, adverse events, in particular, adverse cardiovascular events, were not considered.
CONCLUSIONS: Alvimopan 12 mg can further reduce time to GI recovery and hospital discharge in patients undergoing abdominal surgery within an accelerated recovery program. Investigation into the effect of alvimopan following laparoscopic surgery and additional cost-benefit analyses are required to further define the role of this intervention.
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Is the Placement of the New Synthetic Anal Fistula Plug Really So Ineffective?
No abstract available
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Economic Cost of Fecal Incontinence
BACKGROUND: Despite its prevalence and deleterious impact on patients and families, fecal incontinence remains an understudied condition. Few data are available on its economic burden in the United States.
OBJECTIVE: The aim of this study was to quantify per patient annual economic costs associated with fecal incontinence.
DESIGN: A mail survey of patients with fecal incontinence was conducted in 2010 to collect information on their sociodemographic characteristics, fecal incontinence symptoms, and utilization of medical and nonmedical resources for fecal incontinence. The analysis was conducted from a societal perspective and included both direct and indirect (ie, productivity loss) costs. Unit costs were determined based on standard Medicare reimbursement rates, national average wholesale prices of medications, and estimates from other relevant sources. All cost estimates were reported in 2010 US dollars.
SETTINGS: This study was conducted at a single tertiary care institution.
PATIENTS: The analysis included 332 adult patients who had fecal incontinence for more than a year with at least monthly leakage of solid, liquid, or mucous stool.
MAIN OUTCOME MEASURES: The primary outcome measured was the per patient annual economic costs associated with fecal incontinence.
RESULTS: The average annual total cost for fecal incontinence was $4110 per person (median = $1594; interquartile range, $517–$5164). Of these costs, direct medical and nonmedical costs averaged $2353 (median, $1176; interquartile range, $294–$2438) and $209 (median, $75; interquartile range, $17–$262), whereas the indirect cost associated with productivity loss averaged $1549 per patient annually (median, $0; interquartile range, $0–$813). Multivariate regression analyses suggested that greater fecal incontinence symptom severity was significantly associated with higher annual direct costs.
LIMITATIONS: This study was based on patient self-reported data, and the sample was derived from a single institution.
CONCLUSIONS: Fecal incontinence is associated with substantial economic cost, calling for more attention to the prevention and effective management of this condition.
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Population–Based Evaluation of Adenosquamous Carcinoma of the Colon and Rectum
BACKGROUND: Information about adenosquamous carcinoma of the colon and rectum is scarce because of its extremely low incidence.
OBJECTIVE: The aim of this study was to examine the prognostic significance of a histological diagnosis of adenosquamous carcinoma in comparison with adenocarcinoma of the colon and rectum.
DESIGN: This study was retrospective in design.
SETTING: California Cancer Registry data from 1994 through 2004 with follow–up through 2008 were analyzed.
PATIENTS: Patients were included whose cancer of the colon and rectum, excluding the anus with a tumor histology of adenocarcinoma and adenosquamous carcinoma, was surgically treated.
MAIN OUTCOME MEASURES: The primary outcomes measured were histology–specific survival analyses (with the use of the Kaplan–Meier method), and overall and colorectal–specific mortality (with the use of multivariable Cox proportional hazards regression analyses).
RESULTS: A total of 111,263 adenocarcinoma and adenosquamous carcinoma of colon and rectal cancer cases were identified (adenocarcinoma, 99.91%; adenosquamous carcinoma, 0.09%). There was no significant difference in sex, age, race, and socioeconomic status between the 2 groups. The most common location of adenocarcinoma and adenosquamous carcinoma was the right and transverse colon. The adenosquamous carcinoma group was significantly associated with a higher rate of metastasis at the time of operation (adenosquamous carcinoma, 36.56% vs adenocarcinoma, 13.92%) and with poorly differentiated tumor grade (adenosquamous carcinoma, 65.96% vs adenocarcinoma, 19.74%) in comparison with the adenocarcinoma group. The median overall survival time was significantly greater in the adenocarcinoma group (82.4 months) in comparison with the adenosquamous carcinoma group (35.3 months). With the use of multivariable hazard regression analyses, adenosquamous carcinoma histology was independently associated with increased overall mortality (hazard ratio, 1.67) and colorectal–specific mortality (hazard ratio, 1.69) in comparison with adenocarcinoma.
CONCLUSIONS: This is one of the largest studies of adenosquamous carcinoma of the colon and rectum to date. This uncommon colorectal cancer subtype was associated with higher overall and colorectal–specific mortality in comparison with adenocarcinoma. Among colorectal cancer cases, adenosquamous carcinoma histology should be considered a poor prognostic feature.
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Radiofrequency Treatment for Fecal Incontinence: Is It Effective Long-term?
OBJECTIVE: The aim of this study was to evaluate the short- and long-term outcome of the radiofrequency treatment for moderate to severe fecal incontinence.
DESIGN: This study is a retrospective review of a single-institution experience.
PATIENTS: Patients who underwent the radiofrequency procedure were included.
MAIN OUTCOME MEASURES: The primary outcomes measured were the complication rate, short- and long-term response, and the rate of subsequent intervention for incontinence.
RESULTS: Twenty-seven patients underwent 31 radiofrequency procedures (81% women; mean age, 64 years). Median length of symptoms was 3 years. Biofeedback had failed for 52% of patients, and 23% of patients had previous surgical intervention. Thirty-eight percent of patients had a sphincter defect. Minor complications were observed in 19% of the patients. A treatment response was noted in 78% of the patients (mean Cleveland Clinic Florida Fecal Incontinence Score: 16 (baseline) and 10.9 (3 months postoperatively)). However, a sustained long-term response without any additional intervention was noted in 22% of the patients, and 52% of the patients underwent or are awaiting additional intervention for persistent or recurrent incontinence (mean follow-up, 40 months).
LIMITATION: This study is limited by its retrospective nature and the limited number of subjects.
CONCLUSIONS: The radiofrequency procedure was safe, but a long-term benefit was noted in a minority of patients with moderate to severe fecal incontinence. Additional interventions were required in more than half of the patients. Larger studies are needed to determine the impact of various patient-related factors on the outcome of the radiofrequency treatment to identify the ideal patient for this therapy.
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Risk Factors for Anastomotic Leakage After Colectomy
BACKGROUND: Anastomotic leakage is a morbid and potentially fatal complication of colorectal surgery. Determination of pre- and intraoperative risk factors may identify patients requiring increased postoperative surveillance for this major complication.
OBJECTIVE: The purpose of this study was to identify risk factors associated with anastomotic leakage after colectomy with primary intra-abdominal anastomosis.
DESIGN: The prospective, statewide multicenter Michigan Surgical Quality Collaborative database was analyzed.
SETTING: This study was performed at academic and community medical centers in the state of Michigan.
PATIENTS: Included were all cases of open and laparoscopic colectomy with primary intra-abdominal anastomosis from 2007 through 2010.
MAIN OUTCOME MEASURES: Univariate analysis followed by a multivariate logistic regression model was used to determine the influence of patient factors and operative events with respect to the incidence of postoperative anastomotic leakage.
RESULTS: Inclusion criteria were met by 4340 cases. Anastomotic leakage occurred in 85 (3.2%) of the 2626 (60.5%) open colectomies, and in 51 (3.0%) of the 1714 (39.5%) laparoscopic procedures, which was not significantly different (p = 0.63). Significant risk factors associated with anastomotic leakage based on the multivariate logistic regression model were fecal contamination with OR 2.51, 95% CI, 1.16 to 5.45, p = 0.02; and intraoperative blood loss of more than 100 mL and 300 mL, with OR 1.62, 95% CI, 1.10 to 2.40, p = 0.02; and OR 2.22, 95% CI, 1.32 to 3.76, p = 0.003.
LIMITATIONS: The Michigan Surgical Quality Collaborative colectomy project excluded high-risk rectal resections and low pelvic anastomoses. Information about operative technique and intraoperative events is limited, and anastomotic leakage was determined through chart review.
CONCLUSION: Fecal contamination and increased blood loss during colectomy should raise suspicion for potential postoperative anastomotic leakage.
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The Management of Anastomotic Pouch Sinus After IPAA
BACKGROUND: Anastomotic sinus is a relatively uncommon complication after an IPAA. Disease course is poorly defined, and management can be challenging.
OBJECTIVE: The purpose of this study was to evaluate the frequency, management, and outcome of anastomotic pouch sinus.
DESIGN: This research is a retrospective cohort study from a prospectively collected database.
SETTING: The investigation took place in a high-volume specialized colorectal surgery department.
PATIENTS: Patients with an anastomotic sinus after pouch surgery from 1997 to 2009 were included.
MAIN OUTCOMES MEASURES: The primary outcomes measured were sinus healing and pouch failure.
RESULTS: Of 2286 patients who underwent an IPAA, 45 (2.0%) patients were identified with an anastomotic pouch sinus. There were 32 (71%) males, and the mean age was 40 (±13) years. The pouch sinus was initially managed by observation in 23 (51%) patients, drainage of the sinus in 9 (20%) patients, unroofing of the sinus tract in 8 (18%) patients, sinus closure in 3 (7%) patients, and a diverting ileostomy in 2 (4%) patients. In 28 patients (62%), subsequent treatment was necessary. Sinus healing was achieved in 27 (60%) patients, whereas 15 (33%) eventually developed pouch failure. Of the treatment modalities applied, a strategy with observation as initial treatment was the most successful with a healing rate of 65%. The healing rate was significantly lower in symptomatic patients in comparison with asymptomatic patients (30% vs 84%, p = 0.001). Pouch failure was also higher (45% vs 24%, p = 0.14). No other factors associated with healing rate or pouch failure were identified.
LIMITATIONS: This study was limited by its nonrandomized retrospective design.
CONCLUSION: Anastomotic pouch sinuses after pouch surgery are associated with a high rate of pouch failure. Symptomatic presentation is a significant predictor for low healing rates and is associated with a high risk of pouch failure. Observation and watchful monitoring is the initial treatment of choice when permitted by the patient’s condition.
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Self-Assessment Quiz: Answers, Critiques, and References
No abstract available
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The Author Replies
No abstract available
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Bowel Habits and Fecal Incontinence in Patients With Obesity Undergoing Evaluation for Weight Loss: The Importance of Stool Consistency
BACKGROUND: Fecal incontinence is highly prevalent in the general population and especially in risk groups. Obesity is also common and is associated with comorbidities that impair general health and interfere with daily activities. Identifying mutable factors for fecal incontinence, such as stool consistency, is of paramount importance to improve quality of life.
OBJECTIVE: The aim of this study was to estimate the prevalence of fecal incontinence in patients with obesity undergoing evaluation for weight loss, its relationship with bowel habits, and its impact on quality of life.
DESIGN: This investigation is a cross-sectional observational study.
SETTINGS: This study was conducted in patients with obesity who were undergoing evaluation for weight loss.
MAIN OUTCOME MEASURES: Fecal incontinence was defined as loss of flatus or liquid/solid stool occurring at least monthly. Data on comorbidities, BMI, quality of life, bowel habits including stool consistency measured with the Bristol Stool Form Scale, and symptoms of fecal incontinence were collected.
RESULTS: Fifty-two patients were included, with a mean BMI of 39.6 kg/m2. Symptoms of fecal incontinence were found in 17 patients (32.7%): flatus in 9 of 17 (52.9%), liquid stool in 6 of 17 (35.2%), and solid stool in 2 of 17 (11.7%). No differences were found between patients with and without fecal incontinence in age, sex, comorbidities, or BMI. Health-related quality of life was lower in patients with fecal incontinence than in those without, but this difference was not significant, with the exception of the dimensions of role-physical (p = 0.03) and social functioning (p = 0.04). Patients with incontinence reported significantly higher percentages of altered bowel habits with nonformed stools (p = 0.004).
LIMITATIONS: The cross-sectional design hampered identification of the time at which the impact of obesity occurred.
CONCLUSIONS: Fecal incontinence is common in patients with obesity. Stool consistency was significantly different in these patients. This study supports the possibility of improving incontinence during weight loss by modifying stool consistency.
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Selected Abstracts
No abstract available
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