Vicki Patton

Pancolonic motor response to subsensory and suprasensory sacral nerve stimulation in patients with slow‐transit constipation

Sacral nerve stimulation (SNS) is emerging as a potential treatment for patients with constipation. Although SNS can elicit an increase in colonic propagating sequences (PSs), the optimal stimulus parameters for this response remain unknown. This study evaluated the colonic motor response to subsensory and suprasensory SNS in patients with slow‐transit constipation.

The effect of sacral nerve stimulation on distal colonic motility in patients with faecal incontinence

Sacral nerve stimulation (SNS) is an effective treatment for neurogenic faecal incontinence (FI). However, the clinical improvement that patients experience cannot be explained adequately by changes in anorectal function. The aim of this study was to examine the effect of SNS on colonic propagating sequences (PSs) in patients with FI in whom urgency and incontinence was the predominant symptom.

Quantification of in vivo colonic motor patterns in healthy humans before and after a meal revealed by high-resolution fiber-optic manometry.

Until recently, investigations of the normal patterns of motility of the healthy human colon have been limited by the resolution of in vivo recording techniques.

Colonic motor abnormalities in slow transit constipation defined by high resolution, fibre-optic manometry

Slow transit constipation (STC) is associated with colonic motor abnormalities. The underlying cause(s) of the abnormalities remain poorly defined. In health, utilizing high resolution fiber‐optic manometry, we have described a distal colonic propagating motor pattern with a slow wave frequency of 2–6 cycles per minute (cpm). A high calorie meal caused a rapid and significant increase in this activity, suggesting the intrinsic slow wave activity could be mediated by extrinsic neural input. Utilizing the same protocol our aim was to characterize colonic meal response STC patients.

Treatment Efficacy of Sacral Nerve Stimulation in Slow Transit Constipation: A Two-Phase, Double-Blind Randomized Controlled Crossover Study

Objectives:Sacral nerve stimulation (SNS) is a potential treatment for constipation refractory to standard therapies. However, there have been no randomized controlled studies examining its efficacy. In patients with slow transit constipation, we evaluated the efficacy of suprasensory and subsensory SNS compared with sham, in a prospective, 18-week randomized, double-blind, placebo-controlled, two-phase crossover study. The primary outcome measure was the proportion of patients who, on more than 2 days/week for at least 2 of 3 weeks, reported a bowel movement associated with a feeling of complete evacuation.Methods:After 3 weeks of temporary peripheral nerve evaluation (PNE), all patients had permanent implantation and were randomized to subsensory/sham (3 weeks each) and then re-randomized to suprasensory/sham (3 weeks each) with a 2-week washout period between each arm. Daily stool dairies were kept, and quality of life (QoL; SF36) was measured at the end of each arm.Results:Between November 2006 and March 2012, 234 constipated patients were assessed, of whom 59 were willing and deemed eligible to participate (4 male; median age 42 years). Of the 59 patients, 16 (28%) responded to PNE. Fifty-five patients went on to permanent SNS implantation. The proportion of patients satisfying the primary outcome measure did not differ between suprasensory (30%) and sham (21%) stimulations, nor between subsensory (25%) and sham (25%) stimulations. There were no significant changes in QoL scores.Conclusions:In patients with refractory slow transit constipation, SNS did not improve the frequency of complete bowel movements over the 3-week active period.

Low‐resolution colonic manometry leads to a gross misinterpretation of the frequency and polarity of propagating sequences: Initial results from fiber‐optic high‐resolution manometry studies

High‐resolution manometry catheters are now being used to record colonic motility. The aim of this study was to determine the influence of pressure sensor spacing on our ability to identify colonic propagating sequences (PS).

An optical fiber Bragg grating force sensor for monitoring sub-bandage pressure during compression therapy

Graduated compression bandaging of the lower limbs is the primary therapy for venous leg ulcers with its efficacy believed to be predominantly dependent on the amount and the distribution of the compressive pressure applied. There has been on-going demand for an ideal sensor to facilitate in-vivo monitoring of the sub-bandage pressure. Several methods and devices have been reported but each has its limitations, such as bulkiness, low tolerance to movement, susceptible to thermal noise and single point sensing. An optical fiber force sensor is demonstrated, consisting of two arrays of fiber Bragg grating (FBG) entwined in a double helix form and packaged with contact-force sensitivity. This sensor array has inherent temperature immunity and is capable of real-time, distributed sensing of sub-bandage pressure. The calibration results of the sensor array, as well as the validation human trial results, are presented.

Risk factors for obstetric anal sphincter injuries and postpartum anal and urinary incontinence: a case–control trial

Introduction and hypothesisObstetric anal sphincter injuries (OASIS) cause serious maternal morbidity for mothers. A clearer understanding of aetiological factors is needed. We aimed to determine the risk factors for OASIS .MethodsBirth details of 222 primiparous women sustaining OASIS were compared with 174 women who did not sustain OASIS (controls) to determine the relevant risk factors. The data underwent univariate analysis and logistic regression analysis.ResultsAsian or Indian ethnicity, operative vaginal birth (p = 0.00), persistent occipito-posterior position (p = 0.038) and rapid uncontrolled delivery of the head were identified as risk factors for OASIS. Pushing time, use of epidural, episiotomy and head circumference were not predictors of OASIS.ConclusionsWomen with Asian or Indian ethnicity, operative vaginal birth, persistent occipito-posterior position and rapid uncontrolled delivery of the fetal head were likely to sustain OASIS. Awareness of these factors may help to minimise the incidence of OASIS.

Sacral Nerve Stimulation Fails to Offer Long-term Benefit in Patients With Slow-transit Constipation

BACKGROUND: Sacral nerve stimulation is proposed as a treatment for slow-transit constipation. However, in our randomized controlled trial we found no therapeutic benefit over sham stimulation. These patients have now been followed-up over a long-term period. OBJECTIVE: The purpose of this study was to assess the long-term efficacy of sacral nerve stimulation in patients with scintigraphically confirmed slow-transit constipation. DESIGN: This study was designed for long-term follow-up of patients after completion of a randomized controlled trial. SETTINGS: It was conducted at an academic tertiary public hospital in Sydney. PATIENTS: Adults with slow-transit constipation were included. MAIN OUTCOME MEASURES: At the 1- and 2-year postrandomized controlled trial, the primary treatment outcome measure was the proportion of patients who reported a feeling of complete evacuation on >2 days per week for ≥2 of 3 weeks during stool diary assessment. Secondary outcome was demonstration of improved colonic transit at 1 year. RESULTS: Fifty-three patients entered long-term follow-up, and 1 patient died. Patient dissatisfaction or serious adverse events resulted in 44 patients withdrawing from the study because of treatment failure by the end of the second year. At 1 and 2 years, 10 (OR = 18.8% (95% CI, 8.3% to 29.3%)) and 3 patients (OR = 5.7% (95% CI, –0.5% to 11.9%)) met the primary outcome measure. Colonic isotope retention at 72 hours did not differ between baseline (OR = 75.6% (95% CI, 65.7%–85.6%)) and 1-year follow-up (OR = 61.7% (95% CI, 47.8%–75.6%)). LIMITATIONS: This study only assessed patients with slow-transit constipation. CONCLUSIONS: In these patients with slow-transit constipation, sacral nerve stimulation was not an effective treatment.

Long‐term results of the cutting seton for high anal fistula

No single procedure for high anal fistula delivers a high cure rate while also completely protecting sphincter function. This paper reports our long‐term results with the cutting seton for high fistulae and draws comparisons with advancement flap and ligation of intersphincteric fistula track (LIFT) procedures.