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Achalasia
Published in Mark Davenport, James D. Geiger, Nigel J. Hall, Steven S. Rothenberg, Operative Pediatric Surgery, 2020
More complicated suturing devices have been used (Apollo OverStitchTM; Apollo Endosurgery Inc.; Austin, TX, USA) but require a dual lumen endoscope to perform. The endoscopic functional lumen imaging probe (EndoFLIP®; Medtronics, Minneapolis, MN, USA) may be used during both laparoscopic Heller myotomy and POEM procedures to aid in identifying the adequacy of myotomy using cross-sectional diameter measurements of the EGJ before and after myotomy, as described by Teitelbaum et al. (Figure 30.25).
Specialist Investigation of Anorectal and Colonic Functions
Published in Peter Sagar, Andrew G. Hill, Charles H. Knowles, Stefan Post, Willem A. Bemelman, Patricia L. Roberts, Susan Galandiuk, John R.T. Monson, Michael R.B. Keighley, Norman S. Williams, Keighley & Williams’ Surgery of the Anus, Rectum and Colon, 2019
S. Mark Scott, Andrew B. Williams
Assessment of the anal sphincter using manometry relies on the assumption that pressure (defined as a continuous physical force exerted on or against an object [manometry catheter] by something in contact with it [anus]) is the optimum parameter to describe sphincter function. Others have argued that the anal canal’s passive ability to withstand opening pressure plays a more important role in the continence mechanism, and that ‘distensibility’ is thus a more appropriate (physiological) parameter; indeed, measurement of sphincter yield pressures have been shown to reliably separate sphincters judged competent or incompetent on clinical grounds.127 A dedicated tool for evaluation of the biomechanical properties of tubular organs, and hence ideal for the anus, has been developed over the last decade – the functional lumen imaging probe (Flip®; Crospon, Ireland). The basic principle of the device is that of impedance planimetry, i.e. measurements of the cross-sectional area (CSA) of a saline-filled bag from electrical impedance measurements and of concurrent intrabag pressure during distension. The catheter incorporates several electrodes (the current standard is 16), and is therefore able to measure a longitudinal series of equally spaced CSAs inside the bag (see Figure 16.17a).
Assessment of anal sphincter distensibility following the STARR procedure: a pilot study
Published in Acta Chirurgica Belgica, 2020
Charlotte Desprez, Chloé Melchior, Guillaume Gourcerol, Jean-Jacques Tuech, Estelle Houivet, Anne-Marie Leroi, Valérie Bridoux
The STARR (Stapled Trans-Anal Rectal Resection) procedure consists of a minimally invasive surgical correction of symptomatic rectocele or rectal intussusception [1] refractory to medical treatment. This surgery is associated with an improvement of obstructed defecation syndrome (ODS) in more than 70% of patients [2]. The STARR procedure involves prolonged anal dilatation with a circular anal dilator. Dilatation of the anal canal may contribute to the postoperative alteration of continence observed in approximately 20% of operated patients [2]. However, several studies have investigated anal sphincter function with anorectal manometry after this surgery and did not find any significant changes in the anorectal manometry parameters of patients [2]. Anorectal manometry is not the only available tool to evaluate anal function. The endoluminal functional lumen imaging probe (EndoFLIP®, Ireland) is a new technique for exploring anal canal distensibility during distension and may be superior to anorectal manometry for differentiating between impaired and normal anal sphincter function [3]. The objective of the present study was to determine the impact of the STARR procedure performed in continent patients with rectocele on anal distensibility using the new EndoFLIP® technique.
Anal sphincter dysfunction in patients treated with primary radiotherapy for anal cancer: a study with the functional lumen imaging probe
Published in Acta Oncologica, 2018
Susanne Haas, Pia Faaborg, Donghua Liao, Søren Laurberg, Hans Gregersen, Lilly Lundby, Peter Christensen, Klaus Krogh
Previous studies on late (≥3 months) anorectal toxicity after radiotherapy in AC patients found decreased anal resting pressure and squeeze pressure [16–18]. However, the competence of sphincters is better characterized by their dynamic resistance to distension (distensibility) than by their pressure profile [19–23]. The functional lumen imaging probe (FLIP) allows dynamic and segmental examination of distensibility properties of the anal canal [24–26]. The FLIP technique has previously been employed for studies of geometric and mechanical properties of the anal canal in patients with idiopathic fecal incontinence or with fibrotic degeneration of the internal anal sphincter caused by systemic sclerosis [22,23,27–29].