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Anal Incontinence Improvement After Silicone Injection May Be Related to Restoration of Sphincter Asymmetry

Department of Anorectal Physiology and Coloproctology, Policlínica Geral do Rio de Janeiro, Rio de Janeiro, dralucia{at}uninet.com.br

José Marcio Neves Jorge, MD, PhD

Department of Surgery, University of São Paulo, São Paulo Brazil

Sonia Yussuf, MD

Department of Surgery, University of São Paulo, São Paulo Brazil

Angelita Habr-Gama, MD, PhD

Department of Surgery, University of São Paulo, São Paulo Brazil

Desidério Kiss, MD, PhD

Department of Surgery, University of São Paulo, São Paulo Brazil

Ivan Cecconello, MD, PhD

Department of Anorectal Physiology and Coloproctology, Policlínica Geral do Rio de Janeiro, Rio de Janeiro

Background. This study aimed to evaluate manometric parameters that may explain improvement in anal incontinence using a silicone bulking agent. Methods. Incontinent patients having internal sphincter defects were prospectively selected and injected with a silicone bulking agent. Manometry and endoanal ultrasound were performed before and 3 months after injections. Twenty continent healthy volunteers were used only for manometric comparison. Results. Thirty-five patients (28 females; mean age 60.3 years) and 20 controls entered this study. Patients had lower resting and squeeze pressures compared with controls (P < .05). Length of the high-pressure zone increased from 1 to 1.7 cm postinjection (P = .002). Asymmetry index showed a significant change postinjection (P < .001). Conclusion. Despite considerable clinical improvement, no significant increase in manometric pressures was noted posttreatment. There was significant improvement in both high-pressure zone and asymmetry index, and these findings may explain the mechanism of action of the bulking agent injected.

Key Words: silicone • fecal incontinence • asymmetry index • manometry

Surgical Innovation, Vol. 16, No. 2, 155-161 (2009)
DOI: 10.1177/1553350609338374


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