Abe Tatsuya, Kunimoto Masao, Hachiro Yoshikazu, Ota Shigenori, Ohara Kei, Inagaki Mitsuhiro
Department of Proctology, Kunimoto Hospital, Asahikawa, Japan.
J Anus Rectum Colon. 2022 Jul 28;6(3):174-180. doi: 10.23922/jarc.2022-007. eCollection 2022.
Surgical repair of anal sphincter defects in patients with fecal incontinence (FI) has been associated with excellent or good short-term results; however, its benefits have been shown to deteriorate over long-term follow-up. When sphincteroplasty fails or is not feasible, the subsequent surgical options are limited. This study aimed to evaluate the efficacy of anal encirclement using the Leeds-Keio ligament in patients with FI.
The inclusion criteria for the procedure were failure of or unsuitability for sphincteroplasty and the presence of a patulous anus (diameter, ≥35 mm). The artificial ligament was routed outside the external anal sphincter at the depth of the middle anal canal under caudal epidural anesthesia.
Fourteen patients (mean age, 79.4 years; 8 females) with FI were included. Of these, seven (50%) showed a ≥50% reduction in the Cleveland Clinic Florida Fecal Incontinence Score (CCFIS). The mean CCFIS of 13.6 at baseline significantly improved to 7.9 3 months after surgery. The mean maximal anal resting pressure significantly increased from 16.8 mmHg to 22.6 mmHg. Postoperatively, temporary fecal impaction was observed in one patient (7%). None of the cases required removal of the artificial ligament or additional operative interventions for FI during the mean follow-up period of 31.9 months.
Anal encirclement using the Leeds-Keio ligament was technically simple and safe and achieved good short-term outcomes. Therefore, this technique appears to be a simple solution for sphincter defects and may become an important surgical option for patients with FI and a patulous anus.
大便失禁（FI）患者肛门括约肌缺损的手术修复在短期效果方面表现优异或良好；然而，长期随访显示其益处逐渐减退。当括约肌成形术失败或不可行时，后续的手术选择有限。本研究旨在评估使用利兹 - 庆应韧带进行肛门环扎术对FI患者的疗效。
该手术的纳入标准为括约肌成形术失败或不适用且存在肛门扩张（直径≥35 mm）。在骶管硬膜外麻醉下，将人工韧带置于肛管中部深度的肛门外括约肌外侧。
纳入14例FI患者（平均年龄79.4岁；8例女性）。其中，7例（50%）的佛罗里达克利夫兰诊所大便失禁评分（CCFIS）降低了≥50%。基线时平均CCFIS为13.6，术后3个月显著改善至7.9。平均最大肛门静息压力从16.8 mmHg显著增加至22.6 mmHg。术后，1例患者（7%）出现暂时性粪便嵌塞。在平均31.9个月的随访期内，无一例患者需要取出人工韧带或因FI进行额外的手术干预。
使用利兹 - 庆应韧带进行肛门环扎术技术简单且安全，短期效果良好。因此，该技术似乎是解决括约肌缺损的一种简单方法，可能成为FI和肛门扩张患者的重要手术选择。
