Get 20M+ Full-Text Papers For Less Than $1.50/day. Start a 14-Day Trial for You or Your Team.

Learn More →

Does Implantation of an Artificial Soft Anal Band Provide an Opportunity for Improvement of Biopsychosocial Function in Patients with Severe Fecal Incontinence?

Does Implantation of an Artificial Soft Anal Band Provide an Opportunity for Improvement of... Hindawi Surgery Research and Practice Volume 2019, Article ID 9843164, 7 pages https://doi.org/10.1155/2019/9843164 Research Article Does Implantation of an Artificial Soft Anal Band Provide an Opportunity for Improvement of Biopsychosocial Function in Patients with Severe Fecal Incontinence? Dorota Zelazny , Michał Romaniszyn, and Piotr Wałega ird Chair of Surgery, Jagiellonian University Medical College, Krakow, Poland Correspondence should be addressed to Dorota Zelazny; dorota.ze@op.pl Received 29 August 2019; Accepted 5 October 2019; Published 29 October 2019 Academic Editor: Baran Tokar Copyright © 2019 Dorota Zelazny et al. *is is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Introduction. Severe fecal incontinence describes a condition of complete loss of control over fundamental physiological functions and loss of abilities to fulfil psychosocial functions by the patients. *e last-step procedure, that is, to restore hope for im- provement of biopsychosocial functioning and quality of life determined by the patient’s health status is implantation of an artificial anal sphincter. Objective. *e study was a comparative analysis of the effect of the employed surgical procedure upon the degree of defecation control and quality of life indices in its behavioral, mental, and social aspects prior to and 3, 6, and 12 months postoperatively. *e analysis also included the effect of the patient’s individual style of coping with stress and the functional outcome of the procedure. Material and Methods. *e study included a group of 12 patients: 6 females and 6 males, aged from 36 to 60 years of life. *e tools consisted of scoring systems that measured symptom intensity (FISI and Jorge and Wexner scale). In assessing the psychosocial functioning, the authors employed the Fecal Incontinence Quality of Life Scale (by Rockwood). *e individual mode of coping with the disease was evaluated by using the CISS scale by Endler and Parker. Conclusions. *e analysis of results demonstrated that the procedure of implanting an artificial anal sphincter affected the “continence” (up to 50–60% postoperatively) and led to improvement in psychosocial functioning in all its assessed aspects, i.e., lifestyle, employment of precautionary measures, depression, anxiety, and embarrassment. It was also noted that due to the specific character of the procedure (the necessity to operate an artificial implant), better mean results in assessment of the procedure functionality were achieved by patients presenting the goal-concentrated mode rather than emotions-concentrated mode of coping with the disease. *us, it seems justified to state that assessment of biopsychological functioning may be a good criterion of the procedure effectiveness. view of the devastating effect of loss of control over basic 1. Introduction physiological functions upon their entire sphere of psy- Severe fecal incontinence describes a condition of a complete chosocial functioning. It results in a drastic decrease in quality and prosperity of life that are determined by the loss of control over bowel movements where the method of choice is the last-step procedure—an advanced re- patient’s state of health. construction or abdominal stomy. *ese procedures trigger We do not know which element of the patient’s psyche a tremendous emotional strain and imply a conflict between prompts him to reach a decision to be subjected to an ex- the needs and expectations and the anticipated anxiety as- tensive and strenuous surgical procedure and in what way it sociated with the surgical procedure itself. affects the improvement of the aforementioned “quality of In spite of the above, patients with severe fetal in- life” as a functional effect of the disease and its therapeutic continence resulting from damage to the anal sphincter management [1]. *e last-step procedure that is capable of apparatus seek help in the field of reconstructive surgery in restoring the state approximating a definable model of health 2 Surgery Research and Practice (which in the holistic-functional paradigm in force is treated task, emotions, or avoidance), the patients were also tested as a mutual relation between all the functional structures of once, before the surgery, with a CISS scale by N. S. Endler and J. D. Parker [4]. *e authors analyzed whether indi- the human being and his environment) is transplantation of a hydraulic prosthesis—artificial anal sphincter (AAS). vidual personality traits of the patient affected the evaluation AAS is a soft silicone band that fulfils the role of a of his functioning in the aspect of quality of life, as well as the mechanical valve. It is employed in patients with congenital implemented decision on being subjected to the procedure. (ankyloproctia) or acquired defects of the barrier mecha- *e questionnaire studies, performed both before and nism (traumatic injuries of the pelvis or spinal cord and after the surgical procedure, were supplemented by ex- systemic diseases) in whom, due to lack of anal sphincter or tended, structurized clinical medical history-taking, where its degradation, conservative treatment or other surgical the patients responded to questions referring to the specific procedures cannot be possibly performed. Such operations, character of the procedure itself whether the implantation of successfully done in Europe and the United States, were the artificial device, the necessity of learning how to operate carried out for the first time in Poland in the center the implant, anxiety concerning the faultless functioning of the hydraulic band, or its rejection by the patient’s organism employing the authors in the period 2001–2007. as a foreign body affected their life activities, physical, mental, and social conditions. *e diagnostic conversation 2. Objective also included an element consisting in psychoeducating the *e objective of the study was the analysis of the somato- patient in making his expectations more realistic and getting mental state of patients qualified for the procedure of AAS adjusted to living with an artificial sphincter. implantation and in what way the implantation of an ar- At each stage of the postoperative follow-up examina- tificial anal sphincter changed the selected indices of quality tions, the authors also assessed individual satisfaction levels of life in the behavioral, mental, and social aspects of pa- of the patients. *e subjects responded to the question tients’ functioning. Of significance was also determining the whether they did not regret having been subjected to the correlation between the objectivizing symptomatic exami- procedure of AAS implantation. It should be mentioned that all the patients gave their nations and the subjective sense of controlling one’s body. *e authors also took under consideration whether indi- consent to participate in the study and were informed they vidual traits of the patient, such as coping with stress, af- might refuse to answer certain questions at each stage of the fected the improvement of the aforementioned aspects of investigation (numerous questions, both formulated by the quality of life and whether assessment of psychosocial authors and included in the questionnaires, addressed in- functioning of the patients might provide a good criterion of timate areas) or withdraw their consent to further participate effectiveness of the procedure. in the study. *e Jagiellonian University Bioethical Com- mittee granted their consent to the study. 3. Methods 4. Technique of Surgery In order to objectivize the assessment of the degree of bowel control, the authors employed questionnaires that measured We used a special prosthesis designed basic on gastric band the intensity of symptoms, i.e., the Jorge–Wexner scale [2] used in the treatment of morbid obesity-Soft Anal Band which describes the type of stool, frequency, and the ne- System (AAS, Agency for Medical Innovation; AMI Feld- cessity to change lifestyle (including wearing sanitary pads) kirch Austria, CE Body number 0298, ID 170530317; Reg. on a scale 0 to 20, where 0 means complete control of stool No. 066924MR2). *e prosthesis itself consists of three parts: and gas and 20 means total fecal incontinence. *e second of elastic band, pressure regulating balloon (pump), filled the scales used is FISI(the Fecal Incontinence Scoring Sys- intraoperatively with a radio contrast, and a valve used to tem) [3] which determines the frequency of incontinence of regulate the pressure in the anal band. We used osmotic solid and liquid stool and gas and mucus, on a scale 0 to 61, cleaning to prepare the colon before the procedure and where 0 describes total lack of incontinence and 61 describes metronidazole, an antibiotic, was given before (with pre- no control of physiological functions. *e quality of psy- medication) and after surgery up to 7 days. *e procedure chosocial functioning was evaluated using the Rockwood was performed under general anesthesia, with the patient in scale—Fecal Incontinence Quality of Life, composed of a lithotomic position. In the first step, perianal incisions are total of 29 items. *ese items form four scales: Lifestyle (10 made and a tunnel is created around the anus. Specially items), Coping/Behaviour (9 items), Depression/Self-Per- designed flexible ruler helps to choose an appropriate cuff ception (7 items), and Embarrassment (3 items), analyzing size. Anal band is then placed around the anus. During the dynamic relations between general condition, physiological next step, an incision is made over the pubis and the cali- functions, and their influence on emotional, behavioral, and bration’s port is placed in the subcutaneous space anterior to social zone (with the scores from 0 to 4 and in depression the bladder. *e pump is placed subcutaneously on the side scale from 0 to 6, where a higher score means better coping on the patient’s dominant hand. All components were filled with depression) [3]. *e evaluation was carried out prior to with radio-opaque fluid and connected to create closed the procedure of implanting the artificial anal sphincter hydraulic system. Before discharge from the hospital, all the (AAS) and 3, 6, and 12 months postoperatively. In order to patients were repeatedly trained how to operate the system. determine the style of coping with stress (focused on the *e system was activated under manometric control Surgery Research and Practice 3 *e assessment of all the four aspects of quality of life proceeded by X-ray abdomen imaging, 4–6 weeks after procedure. (FIQL) prior to the procedure and 3, 6, and 12 months postoperatively is illustrated in Figure 2. Results in individual FIQL subscales (Lifestyle, Coping, 5. Results Depression, Embarrassment) for each type of stress man- *e study was carried out in the third chair of surgery, agement are illustrated in Tables 7–10. Jagiellonian University Medical College, Krakow, Poland, in In the follow-up examination in the Lifestyle subscale, the period from 2001 to 2007. A group of 12 patients were we observed an improvement by 0,5 points after 3 months implanted with artificial anal sphincter (none of the patients and further increased by another 0,5 points after 6 months agreed to the proposal before colostomy procedure), 6 fe- postoperatively. Twelve months after surgery, a low increase males and 6 males in the age range of 36 to 60 years of life. of the point scale (by 0,2 points) was still noticeable. In the Coping category, we observed an increase by 0,5 points after *e mean age of the patients was 45 years. Clinical trials were carried out before and 3, 6, and 12 months after surgery 3 and 6 months and by 0,2 points after 12 months after surgery. *e authors noted a measurable improvement in (except scale CISS, examination before surgery). *e quantitative characterization of the individuals the sphere of Embarrassment in the follow-up after 3 qualified for the procedure with respect to the pathogenetic months—2.0 points (an increase by 0.4 point as compared to mechanism is given in Table 1. the initial value of 1.6 points), subsequently 2.2 points (an In the follow-up period, patients remained under con- improvement by another 0.2 points after 6 months), and 2.5 tinuous surgical and psychological care in our Colorectal points (an increase by 2.3 points after 12 months post- Ambulatory Center. In the follow-up, we observed, in one operatively). *e relatively best result in pre- and post- operative evaluation was achieved in the sphere of coping case, one major complication requiring explanation of the whole system: iatrogenic injury to the activator followed by with depression (Depression)—an increase by 0.7 point after 3 months as compared to the initial score of 1.9 points and infection of this site. In two other cases, the system was recalibrated, adding more fluid (after 3 months). In one case by another 0.7 points after 6 months, what summarily amounted to 3.4 points, and by 0.2 points after 12 months in our group, we observed minor wound dehiscence (2nd week) and one case requires additional sutures (2nd week). postoperatively, finally yielding 3.6 points. Taking into In the follow-up, both wounds healed without further consideration the individual results of the patients with complications. It should be mentioned that, in the pre- different styles of coping with stress, it was noticed that the operative period, in order to improve the consistency of best satisfaction (compared to the initial scoring) in all stool, patients used loperamide, after surgery, occasionaly. subscales was presented by the task-concentrated group and *e scores are obtained in the N. S. Endler and J. D. Parker then patients presenting a style of avoidance. *e group concentrated on emotions presented the lowest satisfaction questionnaire, in which the authors categorize coping styles employed in stressful situations into three principal modes, with the functional effect of the treatment. two of them being concentration on the task and concen- tration on emotions, with the third on avoidance, the latter 6. Presentation of Results and Discussion being additionally divided into two subtypes, i.e., avoidance by engaging in alternative activities or in social life, pre- *e review of medical literature demonstrates data on the sented in Table 2. employed method of implanting the hydraulic sphincter In studies using symptomatic scales JW and FISI, we prosthesis, including the mode of implantation, possible observed significant improvement (in relation to the pre- postoperative complications (wound infection, necessity of operative period) in ability to control defecation in the whole employing additional sutures, and revision of the anal group (see Table 3). system, including explantation of the implant), and func- *e comparison of the scores of symptomatic scales tional effects of the procedure itself understood as results of achieved prior to and after the procedure of hydraulic functional examinations and intensification of incontinence prosthesis implantation is presented in Figure 1. symptoms (Wang and Wexner). In the present study, the *e results of patients presenting a specific style of preparation of the patient, surgical technique, and outcomes coping with stress (disease-fecal incontinence) in FISI and did not differ from those described by other authors. JW scales are presented in Tables 4 and 5. Nevertheless, one issue is still under question, namely, in General results of symptomatic scales show significant what way the proposed and performed reconstruction improvement especially in the first three months after the procedure changes the functioning of the patient in its operation, when the degree of “fecal continence” according behavioral, cognitive, emotional, and social aspects. Such an to the FISI scale improved by 12.2 points, and in the JW scale assessment was performed only by Lehur et al. and was based by 2.8 points, improving slightly after 6 months (according on studies of the above authors employing the same in- to FISI, further improvement by 2 points and in JW, by 1.4 vestigative tools and investigating the implantation of the points) and after 12 months postoperatively (FISI-3.8 points device in 19 patients in the years 1996–2000 [5] and by and JW-0.9 points). *e results presented in individual Carmona who studied quality of life after the procedure of groups show a similar tendency to achieve continence. implanting a hydraulic band [6]. In the FIQL scale that measures four aspects of psy- Our results, similar tothe findings of Lehur and Car- chosocial functioning, the mean scores were as given Table 6. mona, show that the employed surgical technique markedly 4 Surgery Research and Practice Table 1: Quantitative division of patients according to pathogenetic mechanism of anal sphincter damage. Mechanism of Congenital defects Spinal injuries with denervation Extensive mechanical pelvic Hemorrhoidectomy pathogenesis ankyloproctia syndrome injuries Subjects 3 3 2 4 Table 2: Quantitative division of patients according to style of coping with stress. Style concentrated on: Task Emotions Avoidance by engaging in alternative activities Avoidance by engaging in social life Subjects 4 4 2 2 Table 3: *e average of the results obtained in FISI and JW scales. friends, and most of all undertaking professional activities. In association with increased mobility, three subjects Evaluation time 0 3 6 12 changed their jobs for more interesting and more financially FISI scale 47,0 34,8 32,8 29,0 advantageous positions. JW scale 12 9,2 7,8 6,9 In case of six patients, the implantation of the artificial anal sphincter denoted undertaking sexual activity and a affected the sense of improved bowel control. *is is il- significant improvement in intimate relations with their lustrated in the patient’s self-assessment based on the FISI partners since it allowed them to conquer their fear of and JW questionnaires. What seems significant is the answer discrediting themselves. to the question whether the fact that one has had an artificial Twelve months after the surgery, the authors observed a anal sphincter implanted (and by the same token, a chance slight increase of satisfaction in the lifestyle sphere, what for regaining self-control over basic physiological functions) denotes the effect of “establishing and getting used” to the may change the remaining spheres of the patient’s func- new situation. tioning. In other words, to be blunt, the question whether it An implication of changes in the sphere of behavioral, may, and if so, in what way, change their lifestyle and reduce and by the same token, also social functioning of the sub- the level of anxiety and depression. jects, was a modification of the so-called cognitive schemas In the investigations carried out by the present authors, of the patients that were evaluated in the Coping category in similar to the reports by Lehur and Carmona, a moderate the FIQL scale, that means beneficial change in self-per- increase of satisfaction was achieved in all the evaluated ception, increased self-assessment, and in consequence aspects of psychosocial functioning. Of particular impor- regaining the sense of the value of one’s body. Ten subjects tance was the significant decrease in depression level, which declared that the image of “their own body with an the presently investigated patients valued the most. implanted system, albeit alien but functioning and providing And thus, one might say that the postoperative sense of a sense of safety, was better than sanitary pads, adult diapers, regaining self-control over defecation affected the modifi- and consequences of their using.” *is exerted an effect on cation of behavioral actions in the lifestyle sphere. In keeping abandoning regressive defensive coping mechanisms char- with the patient’s reports, this mostly resulted from the fact acterized by avoidance and isolation, staying at home, in they no longer needed to use precautionary measures favor of mechanisms aiming at actions and higher activity (pampers) to leave the safe zone, i.e., their home. levels, which was particularly apparent 12 months after the In the period up until the time of calibration and acti- operation. vation of the system, i.e., 4–6 weeks postoperatively, only six *at corresponded to the degree of coping with de- subjects used sanitary napkins as a precaution. After the pression, anxiety, and embarrassment that are prerequisites activation of the band, two patients (in whom the system of stable emotional functioning. *us, the predictability of needed to be recalibrated in the later period) occasionally bowel control reduces the episodes of anxiety and embar- used panty liners, while the remaining subjects from the rassment in social situations, which was a secondary mo- group could give them up. In spite of the necessity of caring tivation for the patients to undertake more psychosocial for and treating the surgical wound, transient pain associ- activities. ated with the operation itself and the necessity to calibrate *e period between the operation and the first follow- the band, as well as learning to operate the activator, the up examination is the period of uncertainty associated patients demonstrated favorable opinions with respect to the with adaptation to and acceptance of the implanted functional effects of the procedure. system and its functioning. It is the period of the nec- As related by the patients, of special importance was essary learning to operate the system, but also of anxiety freeing themselves from the necessity of staying close to a of the inability to defecate when the band fails to loosen toilet and from strict control of nutritional habits. *e effect up. Nevertheless, the results of the evaluation indicate an was a higher activity in fulfilling their social needs, familial, improvement in all the spheres of quality of life. It should societal and professional. For the patients, it meant possi- be added that anxiety regarding the quality of the band bilities of leaving their homes, going to the cinema or functioning involved solely the first follow-up period theater, staying outside their domicile at night, meeting their after the operation. Surgery Research and Practice 5 34,8 32,8 9,2 7,8 6,9 Before Aer 3 mth Aer 6 mth Aer 12 mth FISI JW. Figure 1: Assessment of the degree of fecal incontinence in the FISI and Jorge–Wexner scales before and 3, 6, and 12 months postoperatively. Table 4: Scale FISI, results obtained due to the type of stress management. 0 3 6 12 Group—style concentrated on task 47 34,8 32,5 30,6 Group—style concentrated on emotions 46,0 32,6 30,8 28,0 Group—style concentrated on avoidance, engaging in 46,5 32,2 31,8 28,8 alternative activities Group—style concentrated on avoidance, engaging in 47,0 34,6 33,8 29,2 social life Table 5: Scale JW, results obtained due to the type of stress experienced sense of hopelessness and lack of satisfaction management. over their lives associated with their inability of controlling basic physiological needs did decrease. 0 3 6 12 As it follows from the studies of Lehur, improvement in Group—style concentrated on task 12,6 9,6 8,0 7,0 evaluation of quality of life is the most significant within the Group—style concentrated on emotions 11,6 9,0 7,4 6,5 medial interval after the surgery (approximately 3 to 6 Group—style concentrated on avoidance, 12,0 9,2 7,8 7,0 months), and subsequently, it improves only slightly and engaging in alternative activities may even show decreasing tendencies [5]. In the present Group—style concentrated on avoidance, 14,8 9,0 7,8 7,4 engaging in social life study, the increase of satisfaction after the procedure was the highest in the first two monitored time intervals, after 3 and 6 months, while 12 months after the surgical intervention, it Table 6: *e assessment of all the four aspects of quality of life improved only slightly, which results from the mechanism of (FIQL) prior to the procedure and 3, 6, and 12 months habituation. postoperatively. *e satisfaction of the patients was also evaluated in view 0 3 6 12 of their personal traits (which was a brand-new aspect in this study): the style of coping in difficult situations (most as- Lifestyle 1,8 2,3 2,8 3,0 Coping 2,0 2,5 3,0 3,2 suredly, such a situation is represented by experiencing the Depression 1,9 2,6 3,3 3,5 disease, surgical procedure, and its consequence of being Embarrassment 1,6 2,0 2,6 2,9 dependent on an artificial implant) using the CISS scale. When comparing the scores obtained using the above scale with individual data from the quality of psychosocial functioning scale, the authors noted that in a similar situ- Similarly, as in the case of the abovementioned studies, the present results after 6 and 12 months confirm further ation, implantation of an artificial anal sphincter, the best coping results and the highest level of satisfaction were reduction of the level of anxiety and uncertainty, which is an effect of acceptable control and time-associated pre- characteristic of patients presenting the defensive style, dictability of one’s physiological functions. aiming at actions and activity and searching for solutions of *e relatively best results in pre- and postoperative the problem, and somewhat poorer results were achieved by evaluation were achieved in the sphere of coping with de- subjects who avoided problems using various denial pression (Depression). It proves that the ability to cope with methods or who searched for alternative solutions *e sadness, regrets, negative thoughts involving oneself, and lowest degree of satisfaction derived from the effect of the operation was expressed by the subjects presenting the style one’s future provides a distance from their cause. Eighty percent of the subjects reported that the previously based on emotions. It can be said that personality traits 6 Surgery Research and Practice 3,8 3,6 3,5 3,4 3,3 3,2 3,2 3 3 2,9 2,8 2,8 2,6 2,6 2,6 2,5 2,4 2,3 2,2 1,9 1,8 1,8 1,6 1,6 1,4 1,2 0,8 0,6 0,4 0,2 Before Aer 3 mth Aer 6 mth Aer 12 mth Lifestyle-LS Depression Coping-C Embarrassment Figure 2: Quality of life assessment (FIQL scale) in all categories prior to and 3, 6, and 12 months postoperatively. Table 7: Results of patients presenting different styles of coping Table 10: Results of patients presenting different styles of coping with stress on the Lifestyle subscale. with stress on the Embarrassment subscale. 0 3 6 12 0 3 6 12 Group—style concentrated on task 1,4 2,3 3,0 3,2 Group—style concentrated on task 1,4 2,1 2,6 3,4 Group—style concentrated on emotions 1,6 2,0 2,4 2,5 Group—style concentrated on emotions 1,6 1,8 2,4 3,0 Group—style concentrated on avoidance, Group—style concentrated on avoidance, 2,0 2,2 2,6 2,9 1,8 2,0 2,4 2,7 engaging in alternative activities engaging in alternative activities Group—style concentrated on avoidance, Group—style concentrated on avoidance, 2,2 2,5 2,9 3,2 1,6 1,9 2,3 2,6 engaging in social life engaging in social life Table 8: Results of patients presenting different styles of coping naturally cannot be the main determining factor that with stress on the Coping subscale. qualifies to the implantation of AAS; however, they certainly may affect the functional effect of the surgery (in the pa- 0 3 6 12 tient’s individual evaluation). It seems interesting to answer Group—style concentrated on task 1,8 2,6 3,2 3,4 the question whether the “fight with your own fecal in- Group—style concentrated on emotions 2,0 2,2 3,0 3,0 Group—style concentrated on avoidance, continence” undergoing surgery, may have an impact on 1,8 2,2 2,8 3,0 engaging in alternative activities changing the way of coping with stress. Such research would Group—style concentrated on avoidance, be very interesting from a psychological point of view. 2,2 2,5 3,0 3,2 engaging in social life On the other hand, the individual comparative score addressing the benefits derived from the procedure (data from the medical history-taking) with respect to the mechanism of Table 9: Results of patients presenting different styles of coping sphincter damage pathogenesis indicated that the patients with stress on the Depression subscale. who suffered from ankyloproctia or anal sphincter defects since birth perceived the effect of band implantation as more 0 3 6 12 beneficial since they lacked the previous experience of any Group—style concentrated on task 1,8 2,8 3,4 3,9 type of control over the act of defecation and did not go Group—style concentrated on emotions 2,0 2,4 3,1 3,3 through the trauma of losing such control. Group—style concentrated on avoidance, 2,1 2,4 3,4 3,5 Of significance is also the fact that there was no confir- engaging in alternative activities mation of the signaled preoperatively anxiety of the possibility Group—style concentrated on avoidance, 2,0 2,0 3,0 3,2 engaging in social life of rejecting a foreign object by the patient’s body and Surgery Research and Practice 7 difficulties in ability to operate the implant. *e fact that Evaluation of particular spheres of quality of life in the expectations concerning the functional effect of the procedure process of qualification for surgery is important in achieving a “good functional-psychological response”, also in the sense itself and also some limitations associated with the func- tioning of the entire system earlier rendered more realistic of psychological continence. seemed to trigger beneficial results in adaptation to transient difficulties related to the after-effects of the very procedure. Data Availability In spite of the fact that preparation for surgery was *e data will be available upon request to the corresponding associated with a number of unpleasant examinations, of- author (dorota.ze@op.pl). tentimes of an intimate character, the subjects experienced perioperative anxiety and stress as well as uncertainty as- Conflicts of Interest sociated with their ability of coping with a new situation following AAS implantation and obligation to participate in *e authors declare that they have no conflicts of interest. the follow-up program; all the patients declared they did not regret having undergone the procedure of hydraulic band References implantation (including 1 individual in whom the system had to be explanted). *e authors even observed a tendency [1] H. Schipper, “Quality of life; principles of the clinical para- towards a better opinion on the benefits of the procedure as digm,” Journal of Psychological Oncology, vol. 8, no. 2-3, compared to the data from the questionnaires that objec- pp. 171–185, 1990. [2] N. S. Ruiz and A. M. Kaiser, “Fecal incontinence–challenges tivized the degree of bowel control (the FISI and Jorge– and solutions,” World Journal of Gastroenterology, vol. 23, Wexner scales). *e phenomenon, also described by other no. 1, pp. 11–24, 2017. authors as the psychological continence or the mechanism of [3] T. H. Rockwood, “Incontinence severity and QOL scales for “mental stool retention”, to a high degree, affects all the fecal incontinence,” Gastroenterology, vol. 126, no. 1, evaluated spheres of life. It may suggest that preoperative pp. 106–113, 2004. degradation of quality of life and mental costs associated [4] P. Szczepaniak, J. Strelau, and K. Wrze´sniewski, “Coping in- with the surgery itself as well as the chance for any kind of ventory for stressful situations CISS Endler and Parker,” control exerts a motivating effect on the patient’s self-per- Psychological Review, vol. 39, no. 1, pp. 187–210, 1996. ception as a “continent” person. One might then agree with [5] P.-A. Lehur, F. Zerbib, M. Neunlist, P. Glemain, and S. Bruley Carmona et al. that, in case of an appropriate selection of des Varannes, “Comparison of quality of life and anorectal function after artificial sphincter implantation,” Diseases of the patients, appropriate preparation of a multidisciplinary Colon & Rectum, vol. 45, no. 4, pp. 508–513, 2002. therapeutic team, in spite of possible postoperative com- [6] R. Carmona, “Long-term results of artificial bowel sphincter for plications, retaining the soft anal sphincter band signifi- the treatment of severe fecal incontinence. Are they what we cantly improves the overall biopsychosocial functioning of hoped for?,” Colorectal Disease, vol. 11, no. 8, pp. 831–837, the patient in its quality of life aspect. 7. Conclusions (1) *e results of the present comparative analysis of the effect of the performed surgical procedure, namely, implantation of an artificial anal sphincter show that it significantly affects the control over the act of defecation. (2) *e possibility of controlling and anticipating bowel movements implies changes in all the domains of psychosocial functioning. (3) Appropriate preparation, psychoeducation, and personality traits of the patients affect the surgical effect. (4) Investigating the postoperative psychosocial func- tioning of the patients may be a good criterion of the procedure effectiveness. Despite the risk of failure and possible complications, the procedure of implanting an artificial anal sphincter is an operation that is acceptable for the patients with severe fecal incontinence, and it significantly improves their quality of life. Of utmost significance is regression of the anxiety and depression levels which allows for returning to acceptable forms of everyday social life. MEDIATORS of INFLAMMATION The Scientific Gastroenterology Journal of World Journal Research and Practice Diabetes Research Disease Markers Hindawi Hindawi Publishing Corporation Hindawi Hindawi Hindawi Hindawi www.hindawi.com Volume 2018 http://www www.hindawi.com .hindawi.com V Volume 2018 olume 2013 www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 International Journal of Journal of Immunology Research Endocrinology Hindawi Hindawi www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 Submit your manuscripts at www.hindawi.com BioMed PPAR Research Research International Hindawi Hindawi www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 Journal of Obesity Evidence-Based Journal of Journal of Stem Cells Complementary and Ophthalmology International Alternative Medicine Oncology Hindawi Hindawi Hindawi Hindawi Hindawi www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 www.hindawi.com Volume 2013 Parkinson’s Disease Computational and Behavioural Mathematical Methods AIDS Oxidative Medicine and in Medicine Neurology Research and Treatment Cellular Longevity Hindawi Hindawi Hindawi Hindawi Hindawi www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Surgery Research and Practice Hindawi Publishing Corporation

Does Implantation of an Artificial Soft Anal Band Provide an Opportunity for Improvement of Biopsychosocial Function in Patients with Severe Fecal Incontinence?

Download PDF
8 pages

Loading next page...
 
/lp/hindawi-publishing-corporation/does-implantation-of-an-artificial-soft-anal-band-provide-an-03Kh8SPI9Y

References (8)

Publisher
Hindawi Publishing Corporation
Copyright
Copyright © 2019 Dorota Żelazny et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
ISSN
2356-7759
eISSN
2356-6124
DOI
10.1155/2019/9843164
Publisher site
See Article on Publisher Site

Abstract

Hindawi Surgery Research and Practice Volume 2019, Article ID 9843164, 7 pages https://doi.org/10.1155/2019/9843164 Research Article Does Implantation of an Artificial Soft Anal Band Provide an Opportunity for Improvement of Biopsychosocial Function in Patients with Severe Fecal Incontinence? Dorota Zelazny , Michał Romaniszyn, and Piotr Wałega ird Chair of Surgery, Jagiellonian University Medical College, Krakow, Poland Correspondence should be addressed to Dorota Zelazny; dorota.ze@op.pl Received 29 August 2019; Accepted 5 October 2019; Published 29 October 2019 Academic Editor: Baran Tokar Copyright © 2019 Dorota Zelazny et al. *is is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Introduction. Severe fecal incontinence describes a condition of complete loss of control over fundamental physiological functions and loss of abilities to fulfil psychosocial functions by the patients. *e last-step procedure, that is, to restore hope for im- provement of biopsychosocial functioning and quality of life determined by the patient’s health status is implantation of an artificial anal sphincter. Objective. *e study was a comparative analysis of the effect of the employed surgical procedure upon the degree of defecation control and quality of life indices in its behavioral, mental, and social aspects prior to and 3, 6, and 12 months postoperatively. *e analysis also included the effect of the patient’s individual style of coping with stress and the functional outcome of the procedure. Material and Methods. *e study included a group of 12 patients: 6 females and 6 males, aged from 36 to 60 years of life. *e tools consisted of scoring systems that measured symptom intensity (FISI and Jorge and Wexner scale). In assessing the psychosocial functioning, the authors employed the Fecal Incontinence Quality of Life Scale (by Rockwood). *e individual mode of coping with the disease was evaluated by using the CISS scale by Endler and Parker. Conclusions. *e analysis of results demonstrated that the procedure of implanting an artificial anal sphincter affected the “continence” (up to 50–60% postoperatively) and led to improvement in psychosocial functioning in all its assessed aspects, i.e., lifestyle, employment of precautionary measures, depression, anxiety, and embarrassment. It was also noted that due to the specific character of the procedure (the necessity to operate an artificial implant), better mean results in assessment of the procedure functionality were achieved by patients presenting the goal-concentrated mode rather than emotions-concentrated mode of coping with the disease. *us, it seems justified to state that assessment of biopsychological functioning may be a good criterion of the procedure effectiveness. view of the devastating effect of loss of control over basic 1. Introduction physiological functions upon their entire sphere of psy- Severe fecal incontinence describes a condition of a complete chosocial functioning. It results in a drastic decrease in quality and prosperity of life that are determined by the loss of control over bowel movements where the method of choice is the last-step procedure—an advanced re- patient’s state of health. construction or abdominal stomy. *ese procedures trigger We do not know which element of the patient’s psyche a tremendous emotional strain and imply a conflict between prompts him to reach a decision to be subjected to an ex- the needs and expectations and the anticipated anxiety as- tensive and strenuous surgical procedure and in what way it sociated with the surgical procedure itself. affects the improvement of the aforementioned “quality of In spite of the above, patients with severe fetal in- life” as a functional effect of the disease and its therapeutic continence resulting from damage to the anal sphincter management [1]. *e last-step procedure that is capable of apparatus seek help in the field of reconstructive surgery in restoring the state approximating a definable model of health 2 Surgery Research and Practice (which in the holistic-functional paradigm in force is treated task, emotions, or avoidance), the patients were also tested as a mutual relation between all the functional structures of once, before the surgery, with a CISS scale by N. S. Endler and J. D. Parker [4]. *e authors analyzed whether indi- the human being and his environment) is transplantation of a hydraulic prosthesis—artificial anal sphincter (AAS). vidual personality traits of the patient affected the evaluation AAS is a soft silicone band that fulfils the role of a of his functioning in the aspect of quality of life, as well as the mechanical valve. It is employed in patients with congenital implemented decision on being subjected to the procedure. (ankyloproctia) or acquired defects of the barrier mecha- *e questionnaire studies, performed both before and nism (traumatic injuries of the pelvis or spinal cord and after the surgical procedure, were supplemented by ex- systemic diseases) in whom, due to lack of anal sphincter or tended, structurized clinical medical history-taking, where its degradation, conservative treatment or other surgical the patients responded to questions referring to the specific procedures cannot be possibly performed. Such operations, character of the procedure itself whether the implantation of successfully done in Europe and the United States, were the artificial device, the necessity of learning how to operate carried out for the first time in Poland in the center the implant, anxiety concerning the faultless functioning of the hydraulic band, or its rejection by the patient’s organism employing the authors in the period 2001–2007. as a foreign body affected their life activities, physical, mental, and social conditions. *e diagnostic conversation 2. Objective also included an element consisting in psychoeducating the *e objective of the study was the analysis of the somato- patient in making his expectations more realistic and getting mental state of patients qualified for the procedure of AAS adjusted to living with an artificial sphincter. implantation and in what way the implantation of an ar- At each stage of the postoperative follow-up examina- tificial anal sphincter changed the selected indices of quality tions, the authors also assessed individual satisfaction levels of life in the behavioral, mental, and social aspects of pa- of the patients. *e subjects responded to the question tients’ functioning. Of significance was also determining the whether they did not regret having been subjected to the correlation between the objectivizing symptomatic exami- procedure of AAS implantation. It should be mentioned that all the patients gave their nations and the subjective sense of controlling one’s body. *e authors also took under consideration whether indi- consent to participate in the study and were informed they vidual traits of the patient, such as coping with stress, af- might refuse to answer certain questions at each stage of the fected the improvement of the aforementioned aspects of investigation (numerous questions, both formulated by the quality of life and whether assessment of psychosocial authors and included in the questionnaires, addressed in- functioning of the patients might provide a good criterion of timate areas) or withdraw their consent to further participate effectiveness of the procedure. in the study. *e Jagiellonian University Bioethical Com- mittee granted their consent to the study. 3. Methods 4. Technique of Surgery In order to objectivize the assessment of the degree of bowel control, the authors employed questionnaires that measured We used a special prosthesis designed basic on gastric band the intensity of symptoms, i.e., the Jorge–Wexner scale [2] used in the treatment of morbid obesity-Soft Anal Band which describes the type of stool, frequency, and the ne- System (AAS, Agency for Medical Innovation; AMI Feld- cessity to change lifestyle (including wearing sanitary pads) kirch Austria, CE Body number 0298, ID 170530317; Reg. on a scale 0 to 20, where 0 means complete control of stool No. 066924MR2). *e prosthesis itself consists of three parts: and gas and 20 means total fecal incontinence. *e second of elastic band, pressure regulating balloon (pump), filled the scales used is FISI(the Fecal Incontinence Scoring Sys- intraoperatively with a radio contrast, and a valve used to tem) [3] which determines the frequency of incontinence of regulate the pressure in the anal band. We used osmotic solid and liquid stool and gas and mucus, on a scale 0 to 61, cleaning to prepare the colon before the procedure and where 0 describes total lack of incontinence and 61 describes metronidazole, an antibiotic, was given before (with pre- no control of physiological functions. *e quality of psy- medication) and after surgery up to 7 days. *e procedure chosocial functioning was evaluated using the Rockwood was performed under general anesthesia, with the patient in scale—Fecal Incontinence Quality of Life, composed of a lithotomic position. In the first step, perianal incisions are total of 29 items. *ese items form four scales: Lifestyle (10 made and a tunnel is created around the anus. Specially items), Coping/Behaviour (9 items), Depression/Self-Per- designed flexible ruler helps to choose an appropriate cuff ception (7 items), and Embarrassment (3 items), analyzing size. Anal band is then placed around the anus. During the dynamic relations between general condition, physiological next step, an incision is made over the pubis and the cali- functions, and their influence on emotional, behavioral, and bration’s port is placed in the subcutaneous space anterior to social zone (with the scores from 0 to 4 and in depression the bladder. *e pump is placed subcutaneously on the side scale from 0 to 6, where a higher score means better coping on the patient’s dominant hand. All components were filled with depression) [3]. *e evaluation was carried out prior to with radio-opaque fluid and connected to create closed the procedure of implanting the artificial anal sphincter hydraulic system. Before discharge from the hospital, all the (AAS) and 3, 6, and 12 months postoperatively. In order to patients were repeatedly trained how to operate the system. determine the style of coping with stress (focused on the *e system was activated under manometric control Surgery Research and Practice 3 *e assessment of all the four aspects of quality of life proceeded by X-ray abdomen imaging, 4–6 weeks after procedure. (FIQL) prior to the procedure and 3, 6, and 12 months postoperatively is illustrated in Figure 2. Results in individual FIQL subscales (Lifestyle, Coping, 5. Results Depression, Embarrassment) for each type of stress man- *e study was carried out in the third chair of surgery, agement are illustrated in Tables 7–10. Jagiellonian University Medical College, Krakow, Poland, in In the follow-up examination in the Lifestyle subscale, the period from 2001 to 2007. A group of 12 patients were we observed an improvement by 0,5 points after 3 months implanted with artificial anal sphincter (none of the patients and further increased by another 0,5 points after 6 months agreed to the proposal before colostomy procedure), 6 fe- postoperatively. Twelve months after surgery, a low increase males and 6 males in the age range of 36 to 60 years of life. of the point scale (by 0,2 points) was still noticeable. In the Coping category, we observed an increase by 0,5 points after *e mean age of the patients was 45 years. Clinical trials were carried out before and 3, 6, and 12 months after surgery 3 and 6 months and by 0,2 points after 12 months after surgery. *e authors noted a measurable improvement in (except scale CISS, examination before surgery). *e quantitative characterization of the individuals the sphere of Embarrassment in the follow-up after 3 qualified for the procedure with respect to the pathogenetic months—2.0 points (an increase by 0.4 point as compared to mechanism is given in Table 1. the initial value of 1.6 points), subsequently 2.2 points (an In the follow-up period, patients remained under con- improvement by another 0.2 points after 6 months), and 2.5 tinuous surgical and psychological care in our Colorectal points (an increase by 2.3 points after 12 months post- Ambulatory Center. In the follow-up, we observed, in one operatively). *e relatively best result in pre- and post- operative evaluation was achieved in the sphere of coping case, one major complication requiring explanation of the whole system: iatrogenic injury to the activator followed by with depression (Depression)—an increase by 0.7 point after 3 months as compared to the initial score of 1.9 points and infection of this site. In two other cases, the system was recalibrated, adding more fluid (after 3 months). In one case by another 0.7 points after 6 months, what summarily amounted to 3.4 points, and by 0.2 points after 12 months in our group, we observed minor wound dehiscence (2nd week) and one case requires additional sutures (2nd week). postoperatively, finally yielding 3.6 points. Taking into In the follow-up, both wounds healed without further consideration the individual results of the patients with complications. It should be mentioned that, in the pre- different styles of coping with stress, it was noticed that the operative period, in order to improve the consistency of best satisfaction (compared to the initial scoring) in all stool, patients used loperamide, after surgery, occasionaly. subscales was presented by the task-concentrated group and *e scores are obtained in the N. S. Endler and J. D. Parker then patients presenting a style of avoidance. *e group concentrated on emotions presented the lowest satisfaction questionnaire, in which the authors categorize coping styles employed in stressful situations into three principal modes, with the functional effect of the treatment. two of them being concentration on the task and concen- tration on emotions, with the third on avoidance, the latter 6. Presentation of Results and Discussion being additionally divided into two subtypes, i.e., avoidance by engaging in alternative activities or in social life, pre- *e review of medical literature demonstrates data on the sented in Table 2. employed method of implanting the hydraulic sphincter In studies using symptomatic scales JW and FISI, we prosthesis, including the mode of implantation, possible observed significant improvement (in relation to the pre- postoperative complications (wound infection, necessity of operative period) in ability to control defecation in the whole employing additional sutures, and revision of the anal group (see Table 3). system, including explantation of the implant), and func- *e comparison of the scores of symptomatic scales tional effects of the procedure itself understood as results of achieved prior to and after the procedure of hydraulic functional examinations and intensification of incontinence prosthesis implantation is presented in Figure 1. symptoms (Wang and Wexner). In the present study, the *e results of patients presenting a specific style of preparation of the patient, surgical technique, and outcomes coping with stress (disease-fecal incontinence) in FISI and did not differ from those described by other authors. JW scales are presented in Tables 4 and 5. Nevertheless, one issue is still under question, namely, in General results of symptomatic scales show significant what way the proposed and performed reconstruction improvement especially in the first three months after the procedure changes the functioning of the patient in its operation, when the degree of “fecal continence” according behavioral, cognitive, emotional, and social aspects. Such an to the FISI scale improved by 12.2 points, and in the JW scale assessment was performed only by Lehur et al. and was based by 2.8 points, improving slightly after 6 months (according on studies of the above authors employing the same in- to FISI, further improvement by 2 points and in JW, by 1.4 vestigative tools and investigating the implantation of the points) and after 12 months postoperatively (FISI-3.8 points device in 19 patients in the years 1996–2000 [5] and by and JW-0.9 points). *e results presented in individual Carmona who studied quality of life after the procedure of groups show a similar tendency to achieve continence. implanting a hydraulic band [6]. In the FIQL scale that measures four aspects of psy- Our results, similar tothe findings of Lehur and Car- chosocial functioning, the mean scores were as given Table 6. mona, show that the employed surgical technique markedly 4 Surgery Research and Practice Table 1: Quantitative division of patients according to pathogenetic mechanism of anal sphincter damage. Mechanism of Congenital defects Spinal injuries with denervation Extensive mechanical pelvic Hemorrhoidectomy pathogenesis ankyloproctia syndrome injuries Subjects 3 3 2 4 Table 2: Quantitative division of patients according to style of coping with stress. Style concentrated on: Task Emotions Avoidance by engaging in alternative activities Avoidance by engaging in social life Subjects 4 4 2 2 Table 3: *e average of the results obtained in FISI and JW scales. friends, and most of all undertaking professional activities. In association with increased mobility, three subjects Evaluation time 0 3 6 12 changed their jobs for more interesting and more financially FISI scale 47,0 34,8 32,8 29,0 advantageous positions. JW scale 12 9,2 7,8 6,9 In case of six patients, the implantation of the artificial anal sphincter denoted undertaking sexual activity and a affected the sense of improved bowel control. *is is il- significant improvement in intimate relations with their lustrated in the patient’s self-assessment based on the FISI partners since it allowed them to conquer their fear of and JW questionnaires. What seems significant is the answer discrediting themselves. to the question whether the fact that one has had an artificial Twelve months after the surgery, the authors observed a anal sphincter implanted (and by the same token, a chance slight increase of satisfaction in the lifestyle sphere, what for regaining self-control over basic physiological functions) denotes the effect of “establishing and getting used” to the may change the remaining spheres of the patient’s func- new situation. tioning. In other words, to be blunt, the question whether it An implication of changes in the sphere of behavioral, may, and if so, in what way, change their lifestyle and reduce and by the same token, also social functioning of the sub- the level of anxiety and depression. jects, was a modification of the so-called cognitive schemas In the investigations carried out by the present authors, of the patients that were evaluated in the Coping category in similar to the reports by Lehur and Carmona, a moderate the FIQL scale, that means beneficial change in self-per- increase of satisfaction was achieved in all the evaluated ception, increased self-assessment, and in consequence aspects of psychosocial functioning. Of particular impor- regaining the sense of the value of one’s body. Ten subjects tance was the significant decrease in depression level, which declared that the image of “their own body with an the presently investigated patients valued the most. implanted system, albeit alien but functioning and providing And thus, one might say that the postoperative sense of a sense of safety, was better than sanitary pads, adult diapers, regaining self-control over defecation affected the modifi- and consequences of their using.” *is exerted an effect on cation of behavioral actions in the lifestyle sphere. In keeping abandoning regressive defensive coping mechanisms char- with the patient’s reports, this mostly resulted from the fact acterized by avoidance and isolation, staying at home, in they no longer needed to use precautionary measures favor of mechanisms aiming at actions and higher activity (pampers) to leave the safe zone, i.e., their home. levels, which was particularly apparent 12 months after the In the period up until the time of calibration and acti- operation. vation of the system, i.e., 4–6 weeks postoperatively, only six *at corresponded to the degree of coping with de- subjects used sanitary napkins as a precaution. After the pression, anxiety, and embarrassment that are prerequisites activation of the band, two patients (in whom the system of stable emotional functioning. *us, the predictability of needed to be recalibrated in the later period) occasionally bowel control reduces the episodes of anxiety and embar- used panty liners, while the remaining subjects from the rassment in social situations, which was a secondary mo- group could give them up. In spite of the necessity of caring tivation for the patients to undertake more psychosocial for and treating the surgical wound, transient pain associ- activities. ated with the operation itself and the necessity to calibrate *e period between the operation and the first follow- the band, as well as learning to operate the activator, the up examination is the period of uncertainty associated patients demonstrated favorable opinions with respect to the with adaptation to and acceptance of the implanted functional effects of the procedure. system and its functioning. It is the period of the nec- As related by the patients, of special importance was essary learning to operate the system, but also of anxiety freeing themselves from the necessity of staying close to a of the inability to defecate when the band fails to loosen toilet and from strict control of nutritional habits. *e effect up. Nevertheless, the results of the evaluation indicate an was a higher activity in fulfilling their social needs, familial, improvement in all the spheres of quality of life. It should societal and professional. For the patients, it meant possi- be added that anxiety regarding the quality of the band bilities of leaving their homes, going to the cinema or functioning involved solely the first follow-up period theater, staying outside their domicile at night, meeting their after the operation. Surgery Research and Practice 5 34,8 32,8 9,2 7,8 6,9 Before Aer 3 mth Aer 6 mth Aer 12 mth FISI JW. Figure 1: Assessment of the degree of fecal incontinence in the FISI and Jorge–Wexner scales before and 3, 6, and 12 months postoperatively. Table 4: Scale FISI, results obtained due to the type of stress management. 0 3 6 12 Group—style concentrated on task 47 34,8 32,5 30,6 Group—style concentrated on emotions 46,0 32,6 30,8 28,0 Group—style concentrated on avoidance, engaging in 46,5 32,2 31,8 28,8 alternative activities Group—style concentrated on avoidance, engaging in 47,0 34,6 33,8 29,2 social life Table 5: Scale JW, results obtained due to the type of stress experienced sense of hopelessness and lack of satisfaction management. over their lives associated with their inability of controlling basic physiological needs did decrease. 0 3 6 12 As it follows from the studies of Lehur, improvement in Group—style concentrated on task 12,6 9,6 8,0 7,0 evaluation of quality of life is the most significant within the Group—style concentrated on emotions 11,6 9,0 7,4 6,5 medial interval after the surgery (approximately 3 to 6 Group—style concentrated on avoidance, 12,0 9,2 7,8 7,0 months), and subsequently, it improves only slightly and engaging in alternative activities may even show decreasing tendencies [5]. In the present Group—style concentrated on avoidance, 14,8 9,0 7,8 7,4 engaging in social life study, the increase of satisfaction after the procedure was the highest in the first two monitored time intervals, after 3 and 6 months, while 12 months after the surgical intervention, it Table 6: *e assessment of all the four aspects of quality of life improved only slightly, which results from the mechanism of (FIQL) prior to the procedure and 3, 6, and 12 months habituation. postoperatively. *e satisfaction of the patients was also evaluated in view 0 3 6 12 of their personal traits (which was a brand-new aspect in this study): the style of coping in difficult situations (most as- Lifestyle 1,8 2,3 2,8 3,0 Coping 2,0 2,5 3,0 3,2 suredly, such a situation is represented by experiencing the Depression 1,9 2,6 3,3 3,5 disease, surgical procedure, and its consequence of being Embarrassment 1,6 2,0 2,6 2,9 dependent on an artificial implant) using the CISS scale. When comparing the scores obtained using the above scale with individual data from the quality of psychosocial functioning scale, the authors noted that in a similar situ- Similarly, as in the case of the abovementioned studies, the present results after 6 and 12 months confirm further ation, implantation of an artificial anal sphincter, the best coping results and the highest level of satisfaction were reduction of the level of anxiety and uncertainty, which is an effect of acceptable control and time-associated pre- characteristic of patients presenting the defensive style, dictability of one’s physiological functions. aiming at actions and activity and searching for solutions of *e relatively best results in pre- and postoperative the problem, and somewhat poorer results were achieved by evaluation were achieved in the sphere of coping with de- subjects who avoided problems using various denial pression (Depression). It proves that the ability to cope with methods or who searched for alternative solutions *e sadness, regrets, negative thoughts involving oneself, and lowest degree of satisfaction derived from the effect of the operation was expressed by the subjects presenting the style one’s future provides a distance from their cause. Eighty percent of the subjects reported that the previously based on emotions. It can be said that personality traits 6 Surgery Research and Practice 3,8 3,6 3,5 3,4 3,3 3,2 3,2 3 3 2,9 2,8 2,8 2,6 2,6 2,6 2,5 2,4 2,3 2,2 1,9 1,8 1,8 1,6 1,6 1,4 1,2 0,8 0,6 0,4 0,2 Before Aer 3 mth Aer 6 mth Aer 12 mth Lifestyle-LS Depression Coping-C Embarrassment Figure 2: Quality of life assessment (FIQL scale) in all categories prior to and 3, 6, and 12 months postoperatively. Table 7: Results of patients presenting different styles of coping Table 10: Results of patients presenting different styles of coping with stress on the Lifestyle subscale. with stress on the Embarrassment subscale. 0 3 6 12 0 3 6 12 Group—style concentrated on task 1,4 2,3 3,0 3,2 Group—style concentrated on task 1,4 2,1 2,6 3,4 Group—style concentrated on emotions 1,6 2,0 2,4 2,5 Group—style concentrated on emotions 1,6 1,8 2,4 3,0 Group—style concentrated on avoidance, Group—style concentrated on avoidance, 2,0 2,2 2,6 2,9 1,8 2,0 2,4 2,7 engaging in alternative activities engaging in alternative activities Group—style concentrated on avoidance, Group—style concentrated on avoidance, 2,2 2,5 2,9 3,2 1,6 1,9 2,3 2,6 engaging in social life engaging in social life Table 8: Results of patients presenting different styles of coping naturally cannot be the main determining factor that with stress on the Coping subscale. qualifies to the implantation of AAS; however, they certainly may affect the functional effect of the surgery (in the pa- 0 3 6 12 tient’s individual evaluation). It seems interesting to answer Group—style concentrated on task 1,8 2,6 3,2 3,4 the question whether the “fight with your own fecal in- Group—style concentrated on emotions 2,0 2,2 3,0 3,0 Group—style concentrated on avoidance, continence” undergoing surgery, may have an impact on 1,8 2,2 2,8 3,0 engaging in alternative activities changing the way of coping with stress. Such research would Group—style concentrated on avoidance, be very interesting from a psychological point of view. 2,2 2,5 3,0 3,2 engaging in social life On the other hand, the individual comparative score addressing the benefits derived from the procedure (data from the medical history-taking) with respect to the mechanism of Table 9: Results of patients presenting different styles of coping sphincter damage pathogenesis indicated that the patients with stress on the Depression subscale. who suffered from ankyloproctia or anal sphincter defects since birth perceived the effect of band implantation as more 0 3 6 12 beneficial since they lacked the previous experience of any Group—style concentrated on task 1,8 2,8 3,4 3,9 type of control over the act of defecation and did not go Group—style concentrated on emotions 2,0 2,4 3,1 3,3 through the trauma of losing such control. Group—style concentrated on avoidance, 2,1 2,4 3,4 3,5 Of significance is also the fact that there was no confir- engaging in alternative activities mation of the signaled preoperatively anxiety of the possibility Group—style concentrated on avoidance, 2,0 2,0 3,0 3,2 engaging in social life of rejecting a foreign object by the patient’s body and Surgery Research and Practice 7 difficulties in ability to operate the implant. *e fact that Evaluation of particular spheres of quality of life in the expectations concerning the functional effect of the procedure process of qualification for surgery is important in achieving a “good functional-psychological response”, also in the sense itself and also some limitations associated with the func- tioning of the entire system earlier rendered more realistic of psychological continence. seemed to trigger beneficial results in adaptation to transient difficulties related to the after-effects of the very procedure. Data Availability In spite of the fact that preparation for surgery was *e data will be available upon request to the corresponding associated with a number of unpleasant examinations, of- author (dorota.ze@op.pl). tentimes of an intimate character, the subjects experienced perioperative anxiety and stress as well as uncertainty as- Conflicts of Interest sociated with their ability of coping with a new situation following AAS implantation and obligation to participate in *e authors declare that they have no conflicts of interest. the follow-up program; all the patients declared they did not regret having undergone the procedure of hydraulic band References implantation (including 1 individual in whom the system had to be explanted). *e authors even observed a tendency [1] H. Schipper, “Quality of life; principles of the clinical para- towards a better opinion on the benefits of the procedure as digm,” Journal of Psychological Oncology, vol. 8, no. 2-3, compared to the data from the questionnaires that objec- pp. 171–185, 1990. [2] N. S. Ruiz and A. M. Kaiser, “Fecal incontinence–challenges tivized the degree of bowel control (the FISI and Jorge– and solutions,” World Journal of Gastroenterology, vol. 23, Wexner scales). *e phenomenon, also described by other no. 1, pp. 11–24, 2017. authors as the psychological continence or the mechanism of [3] T. H. Rockwood, “Incontinence severity and QOL scales for “mental stool retention”, to a high degree, affects all the fecal incontinence,” Gastroenterology, vol. 126, no. 1, evaluated spheres of life. It may suggest that preoperative pp. 106–113, 2004. degradation of quality of life and mental costs associated [4] P. Szczepaniak, J. Strelau, and K. Wrze´sniewski, “Coping in- with the surgery itself as well as the chance for any kind of ventory for stressful situations CISS Endler and Parker,” control exerts a motivating effect on the patient’s self-per- Psychological Review, vol. 39, no. 1, pp. 187–210, 1996. ception as a “continent” person. One might then agree with [5] P.-A. Lehur, F. Zerbib, M. Neunlist, P. Glemain, and S. Bruley Carmona et al. that, in case of an appropriate selection of des Varannes, “Comparison of quality of life and anorectal function after artificial sphincter implantation,” Diseases of the patients, appropriate preparation of a multidisciplinary Colon & Rectum, vol. 45, no. 4, pp. 508–513, 2002. therapeutic team, in spite of possible postoperative com- [6] R. Carmona, “Long-term results of artificial bowel sphincter for plications, retaining the soft anal sphincter band signifi- the treatment of severe fecal incontinence. Are they what we cantly improves the overall biopsychosocial functioning of hoped for?,” Colorectal Disease, vol. 11, no. 8, pp. 831–837, the patient in its quality of life aspect. 7. Conclusions (1) *e results of the present comparative analysis of the effect of the performed surgical procedure, namely, implantation of an artificial anal sphincter show that it significantly affects the control over the act of defecation. (2) *e possibility of controlling and anticipating bowel movements implies changes in all the domains of psychosocial functioning. (3) Appropriate preparation, psychoeducation, and personality traits of the patients affect the surgical effect. (4) Investigating the postoperative psychosocial func- tioning of the patients may be a good criterion of the procedure effectiveness. Despite the risk of failure and possible complications, the procedure of implanting an artificial anal sphincter is an operation that is acceptable for the patients with severe fecal incontinence, and it significantly improves their quality of life. Of utmost significance is regression of the anxiety and depression levels which allows for returning to acceptable forms of everyday social life. MEDIATORS of INFLAMMATION The Scientific Gastroenterology Journal of World Journal Research and Practice Diabetes Research Disease Markers Hindawi Hindawi Publishing Corporation Hindawi Hindawi Hindawi Hindawi www.hindawi.com Volume 2018 http://www www.hindawi.com .hindawi.com V Volume 2018 olume 2013 www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 International Journal of Journal of Immunology Research Endocrinology Hindawi Hindawi www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 Submit your manuscripts at www.hindawi.com BioMed PPAR Research Research International Hindawi Hindawi www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 Journal of Obesity Evidence-Based Journal of Journal of Stem Cells Complementary and Ophthalmology International Alternative Medicine Oncology Hindawi Hindawi Hindawi Hindawi Hindawi www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 www.hindawi.com Volume 2013 Parkinson’s Disease Computational and Behavioural Mathematical Methods AIDS Oxidative Medicine and in Medicine Neurology Research and Treatment Cellular Longevity Hindawi Hindawi Hindawi Hindawi Hindawi www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 www.hindawi.com Volume 2018

Journal

Surgery Research and Practice – Hindawi Publishing Corporation

Published: Oct 29, 2019

There are no references for this article.