Application of Bulking Agent «Dam+» in Treatment Organic and Neurogenic Fecal Incontinence in Children

Relevance One of the reasons of organic and neurogenic fecal incontinence in children is low resting pressure in the anal canal. The purpose of the study The purpose of this article is to study the possibilities of using bulking agent «DAM+» for increasing resting pressure in the anal canal in children with fecal incontinence, and evaluate the results of this treatment. Materials and methods The study included clinical and experimental parts. Experimental part was done on Rat Model. Bulking agent «DAM+» was introduced into submucosal layer and zone of anal sphincter each rat. All boluses were measured and histological assessment was done at 1, 2, 3 weeks and 1, 3 month. Clinical study has been performed since 2007 for 2012; The 31 patient with organic or neurogenic fecal incontinence were underwent 55 procedure of introduction polyacrylamid gel «DAM+» into submucosal layer. Patients with overflow incontinence were excluded. Assessment of anorectal zone and pelvic floor included anal manometry, irrigografy, ballonoproctografy and in some cases, computed tomography was done for revealing injuries of puborectal muscle. Results and their discussion In the course of experimental study, it turned out that boluses, introduced into submucosal layer remained in stable size. Histological assessment was shown, that «DAM+» fixed into submucosal layer better than in sphincters layer. At 1 month it was detected vascular invasion of boluses, moreover «DAM+» was surrounded by thin layer of granulation tissue. Amount of resting pressure in the anal canal before and after operation also in long-term period were analyzed. The average quantity of resting pressure in the anal canal before operation is formed 20.98 ± 5.17 сm. (H2O), after operation 32.62 ± 6.63 сm. (H2 O), in long-term period 28.07 ± 6.65 сm. (H2 O) Conclusion «DAM+» should be introduced into submucosal layer. At 12 month efficiency of procedure can be decreased, however resting pressure in the anal canal remain higher than before treatment. The clinical efficiency of procedure correlates with values of resting pressure in the anal canal before and after treatment.

Fecal incontinence, bulking agent «DAM+», resting pressure