Treatment Outcome of Acute Sacral Nerve Stimulation in Functional Anorectal Pain.

BACKGROUND: Sacral nerve stimulation (SNS) has revolutionized the management of certain intractable cases of fecal and urinary incontinence; however, the management of functional anorectal pain (FAP) has been addressed in only a few studies. OBJECTIVE: The aim of this study was to evaluate the treatment effect of SNS in improving FAP symptoms. METHODS: A total of 120 patients with FAP who had undergone temporary SNS probe placement were investigated at Qianfoshan Hospital between January 2014 and December 2016. Pre- and post-SNS treatment outcomes were assessed using the VAS, anorectal manometry, and the 36-item short-form health survey (SF-36) medical outcomes study instrument. RESULTS: A total of 120 patients proceeded to insertion of an SNS probe at the S3 nerve root (2 Hz, 1.50 mA, 0.10 milliseconds). Of these, 75 patients were cured, 41 improved, and 4 had an ineffective outcome. The total effectiveness rate was 96.7% 1 year after treatment. There was a significant reduction in the median VAS score pre-SNS and post-SNS, from 8 to 3, respectively. Patients post-SNS had lower anal maximum contraction pressure and anal rest pressure than did patients pre-SNS. Compared with the pretreatment group, there were no substantial differences between anal longest contraction time and rectal rest pressure. In addition to general health, there was a substantial improvement in the remaining dimension scores of the SF-36. CONCLUSION: The effect of SNS in treating FAP was positive, and the improvement of symptoms was substantial and worthy of clinical promotion.

Magnetic resonance imaging study on the correlation between changes in the puborectalis muscle and posterior perianal abscess / 中华普通外科杂志

Objective To investigate the correlation between posterior perianal abscess and thickness of the puborectalis muscle by magnetic resonance imaging.Methods Sixty-three patients with a low-position posterior perianal abscess (the low-position group),44 patients with a high-position posterior perianal abscess (the high-position group) and 46 healthy volunteers (the control group) were enrolled in this study.In the lithotomy position,MRI was performed to measure the thicknesses of the puborectalis muscle at the 5,6 and 7 o'clock positions of the rectum.Results The thickness of puborectalis muscle at 5,6 and 7 o'clock points in the control group was (5.5 ±0.8),(9.0 ±0.7),(5.4 ±0.6) mm,while that in the low-position group was (5.4 ± 0.7),(10.0 ± 0.9),(5.5 ± 0.7) mm,and that in the high-position group was (7.3 ± 1.0),(11.7-1.2),(7.5 ±0.9) mm,respectively.The thicknesses of the puborectalis muscle at the 5,6,and 7 o'clock positions of the rectum in the lithotomy position were compared between the control group and the low-position group.The difference in the thickness at the 6 o'clock position was statistically significant(t =6.492,P ＜ 0.05),but there were no significant differences at 5 and 7 points (t =-0.719,0.633,P＞0.05).The thicknesses of the pubqrectalis muscle at the 5,6 and 7 o'clock positions of the rectum in the lithotomy position were compared between the control group and the high-position group,and the differences were statistically significant at each position (t =9.476,12.875,13.649,P ＜ 0.05).Simultaneously,the differences between the low-position group and the high-position group were statistically significant(t =-11.206,-7.835,-13.361,P ＜ 0.05).Conclusions Magnetic resonance imaging can diagnose perianal abscess in different parts by measuring the thickness of puborectal muscle,which provides strong evidence for early intervention treatment,so as to improve the therapeutic effect and reduce post-operative anal fistula.