Radiofrequency Anal Sphincter Remodeling: The Influence of Patient Selection on Long-Term Outcome

Poster Presented at 23rd Annual International Colorectal Disease Symposium February 2012.

BACKGROUND & AIMS: Radiofrequency Anal Sphincter’s Remodeling (SECCA) was proposed as minimally invasive treatment of fecal incontinence(FI) irrespectively FI pathophysiology. The aim of this study was to evaluate the influence of patient selection on clinical/physiological outcome during long term follow-up.

PATIENTS & METHODS: In the prospective (from 2005 to 2011), non-randomized, observational trial all 30 FI patients were included. Patients were divided in two groups based on FI pathology: Group I - 18 patients with idiopathic or pudendopathy related FI and Group II - 12 patients with post-traumatic FI. The primary study endpoints covered: FI Indexes (CCF-FI, FISI) and FIQoL at 0, 6, 12, 24 and 36 months. Secondary endpoints included: results of anorectal manometry (ARM), S-EMG,and transanal US (TAUS).

RESULTS: There were no intra- or immediate post-operative complications. The mean time of surgery was 38 minutes in Group I and 48 in Group II. The number of RF delivery points were higher in group I vs II (64 vs 44). Late complications: haematoma (2), fever (1), mucosal errosions (2) appeared in Group II. Group I revealed significantly better FI symptoms resolution at 6, 12, 24 and 36 months. CCF-FI were reduced in Group I from 12.1 to 6.8; while in Group II from 13.2 to 8.6 (0 vs 36 months). Resting Anal Pressure increased from 24.6 to 32.4 (Gr I) and from 20.2 to 26.8 (Gr II); Squeeze Pressure from 63.1 to 76.3 (Gr I) and from 48.4 to 53.6 Gr II. S-EMG parameters increased significantly in Group I. TAUS revealed significant thickening of IAS (at 6 months) in group I patients.

CONCLUSION: Radiofrequency Anal Sphincter Remodeling appeared safe and effective method of FI treatment in long-term observation. It reduces the frequency and sever­ity of FI symptoms, improves patient’s life quality and ARM parameters. This effect is more pronounced in patients with idiopathic or pudendopathy related fecal incontinence, therefore preoperative patients selection may influence the final treatment outcome.