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Biofeedback Therapy Before Ileostomy Closure in Patients Undergoing Sphincter-Saving Surgery for Rectal Cancer: A Pilot Study

대한대장항문학회지 2015년 31권 4호 p.138 ~ 143
 ( Kim Jeong-Ki ) - Seoul National University College of Medicine Department of Surgery

 ( Jeon Byeong-Geon ) - Daejin Medical Center Bundang Jesaeng General Hospital
 ( Song Yoon-Suk ) - Seoul National University College of Medicine Department of Surgery
 ( Seo Mi-Sun ) - Seoul National University College of Medicine Department of Surgery
 ( Kwon Yoon-Hye ) - Seoul National University College of Medicine Department of Surgery
 ( Park Ji-Won ) - Seoul National University College of Medicine Department of Surgery
 ( Ryoo Seung-Bum ) - Seoul National University College of Medicine Department of Surgery
 ( Jeong Seung-Yong ) - Seoul National University College of Medicine Department of Surgery
 ( Park Kyu-Joo ) - Seoul National University College of Medicine Department of Surgery

Abstract


Purpose
This study prospectively investigated the effects of biofeedback therapy on objective anorectal function and subjective bowel function in patients after sphincter-saving surgery for rectal cancer.

Methods
Sixteen patients who underwent an ileostomy were randomized into two groups, one receiving conservative management with the Kegel maneuver and the other receiving active biofeedback before ileostomy closure. Among them, 12 patients (mean age, 57.5 years; range, 38 to 69 years; 6 patients in each group) completed the study. Conservative management included lifestyle modifications, Kegel exercises, and medication. Patients were evaluated at baseline and at 1, 3, 6, and 12 months after ileostomy closure by using anal manometry, modified Wexner Incontinence Scores (WISs), and fecal incontinence quality of life (FI-QoL) scores.

Results
Before the ileostomy closure, the groups did not differ in baseline clinical characteristics or resting manometric parameters. After 12 months of follow-up, the biofeedback group demonstrated a statistically significant improvement in the mean maximum squeezing pressure (from 146.3 to 178.9, P = 0.002). However, no beneficial effect on the WIS was noted for biofeedback compared to conservative management alone. Overall, the FI-QoL scores were increased significantly in both groups after ileostomy closure (P = 0.006), but did not differ significantly between the two groups.

Conclusion
Although the biofeedback therapy group demonstrated a statistically significant improvement in the maximum squeezing pressure, significant improvements in the WISs and the FI-QoL scores over time were noted in both groups. The study was terminated early because no therapeutic benefit of biofeedback had been demonstrated.

키워드

Feedback; Ileostomy; Manometry; Fecal incontinence
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