The MFA: a new device for early patients’ selection PC Meinero, L Mori, M. Estienne, N. Massa. S.S. Proctologia - Osped

1. The MFA: a new device for early patients’ selection PC Meinero, L Mori, M. Estienne, N. Massa.S.S. Proctologia - Ospedale E. Riboli - Lavagna (Genova)‏ Introduction During the first proctological examination we can’t detect anorectal functionality. Nowadays, with minor pathologies where manometry is not foreseen, no instrument is able to predict attendant diseases and postoperatory complications. The MFA takes its place between nothing and manometry, allowing the selection of patients with hyper- or hypo-rectalsensitivity. Both rectal hypersensitivity and hyposensitivity are correlated with pathologies that the proctologist might suspect; so he’ll be able to carry out further examinations. Fig. 1 Materials and methods The MFA is made up of a graduated anoscope and a catheter with latex balloon. It is “multifunctional” as it can perform: 1) Rectal-Sensation-Test (RST)‏ It is started by insufflating cc-air (Fig 2) . First Sensation (FS), Defecatory Desire Volume (DDV), Maximum Tolerable Volume (MTV) will be obtained. Normal values are FS 30-60 , DDV 60-160 , MTV 160-270. If different from normal range Rectal-hypersensitivity or hyposensitivity are identified. 2) Balloon-Expulsion-Test (BET)‏ Inability to expel the balloon confirms the anismus or ODS suspiction. 3) Extent of Prolapse Assessment (EPA) Fig.3 It can influence the proctologist’s decision to utilize one or two staplers for the prolapse resection. That’s also useful in compiling the consent form. 4) Length Measurement of Anal Canal (LMAC) Fig 4 It’s useful when the operation aim is to lengthen the anal canal. Increased anal canal length and MTV value are also predictive of the biofeedback bed results in patients with anismus. Fig. 2 The use of the MFA at the first proctological visit allows: to perform Rectal Sensation Test in case of minor pathologies, too; to suspect attendant diseases; to foresee postoperatory complications; to avoid hurried surgical decisions; to assess the correct prolapse extent and finally to foresee biofeedback results. Fig. 3 Fig. 4 Results In 189 patients studied, 30 were found with hypersensitivity (seven patients with external sphincter disfuncions), 47 with hyposensitivity (eight with anismus, two with faecal incontinence). All patients were examined with both the MFA and manometry: identical results because the technique is the same. Fig. 5 123 patients with haemorrhoids were operated by stapled prolassectomy, 43 with ODS by STARR (Fig.6). In the six month follow-up Defecatory Urgency (DU) was considered and divided into Temporary (TDU), Permanent (PDU) and Severe (SDU) Fig.7. From this preliminary study there’s a clear correlation between rectal-hypersensitivity, DU and SDU (p<0.001). Fig. 8 Fig. 5 Fig. 6 Fig. 7 Fig. 8 Discussion References Marc A. Gladman, M.R.C.O.G., M.R.C.S. (Eng), S. Mark Scott, Ph.D., Christopher L.H. Chan, F.R.C.S., Norman S. Williams, M.S., F.R.C.S., Peter J. Lunniss, M.S., F.R.C.S.: “Rectal Hyposensitivity. Prevalence and Clinical Impact in Patients With Intractable Constipation and Fecal Incontinence”. D.C.R. 2003 Vol.46, N°2: 238-246. Christopher L.H. Chan, F.R.C.S., S. Mark Scott, Ph.D., Norman S. Williams, F.R.C.S., Peter J. Lunnis, F.R.C.S. “Rectal Hypersensitivity Worsens Stool Frequency, Urgency and Lifestyle in Patients With Urge Fecal Incontinence”. D.C.R. 2005 Vol. 48, N°1: 134-140.