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Dis Colon Rectum. 2003 Jun;46(6):711-5.
Extended two-year results of radio-frequency energy delivery for the treatment of fecal incontinence (the Secca procedure).

Takahashi T, Garcia-Osogobio S, Valdovinos MA, Belmonte C, Barreto C, Velasco L.

Service of Colon and Rectal Surgery, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico.

PURPOSE: This study evaluated the durability and long-term safety of radio-frequency energy delivery for fecal incontinence (Secca procedure). METHODS: This was an extended follow-up of a prospective study in which patients with fecal incontinence of various causes underwent radio-frequency energy delivery to the anal canal muscle. The Cleveland Clinic Florida Fecal Incontinence Scale (0-20), fecal incontinence-related quality-of-life score, and Medical Outcomes Study Short Form 36 were administered at baseline and at 1, 2, 3, 6, 12, and 24 months after the procedure. Differences between baseline and follow-up were analyzed with the Wilcoxon signed-rank test. RESULTS: Ten females (aged 55.9 +/- 9.2 (range, 44-74) years) were treated. At two-year follow-up, the mean Cleveland Clinic Florida Fecal Incontinence Scale score was improved from 13.8 to 7.3 (P = 0.002), with eight patients having scores of < or =10. All fecal incontinence-related quality-of-life score parameters were improved, including lifestyle (from 2.3 to 3.3; P = 0.002), coping (from 1.7 to 2.7; P = 0.002), depression (from 2.4 to 3.4; P = 0.004), and embarrassment (from 1.5 to 2.4; P = 0.008). There was no decrement in effect noted in any parameter between 12 and 24 months (P > 0.2). The social function component of the Short Form 36 improved from 50 to 82.5 (P = 0.04), whereas there was an improvement trend for the mental component summary of the Short Form 36 from 38.3 to 48.1 (P = 0.11). Protective pad use was eliminated in four of the seven baseline users. There were no long-term complications, such as stricture, pain, or constipation. CONCLUSIONS: A



Dis Colon Rectum. 2003 Jun;46(6):809-17.
Colorectal motility induction by sacral nerve electrostimulation in a canine model: implications for colonic pacing.

Hirabayashi T, Matsufuji H, Yokoyama J, Hagane K, Hoshino K, Morikawa Y, Kitajima M.

Department of Surgery, Keio University, Tokyo, Japan.

PURPOSE: This study investigated the role of the sacral nerves in the mechanism of defecation using adult mongrel dogs. The possibility of designing a colonic pacemaker as a new therapeutic device to treat defecation disturbances, such as fecal incontinence and severe constipation, is also discussed. METHODS: Colorectal motility during spontaneous defecation was monitored with force strain-gauge transducers implanted in the proximal, distal, and sigmoid colon, rectum, and internal anal sphincter. Under general anesthesia, the sacral nerve was stimulated electrically, and the colorectal motility response was examined. RESULTS: During spontaneous defecation, three characteristic motility patterns were observed: 1) giant migrating contractions of the colon were propagated to the rectum or anus; 2) the rectum relaxed before the giant migrating contractions were propagated; and 3) the internal anal sphincter was relaxed during the propagation of the giant migrating contraction. Sacral nerve stimulation elicited the following three unique responses: 1) contractile movements were propagated from the distal colon to the rectum; 2) a relaxation response was noted in the rectum; and 3) the internal anal sphincter exhibited a relaxation response. The duration and propagation velocity of the contractile responses and the duration of relaxation responses elicited by electrical stimulation of the sacral nerve were similar to those that occurred during spontaneous defecation, but their amplitudes were smaller. CONCLUSION: The coordinated processes of the colon and anorectum during defecation were affected by the sacral nerves. This suggests that it is possible to design a colonic pacemaker to control lower colonic



Schmerz. 1996 Oct 28;10(5):254-60.
[Constipation after tilidine/naloxone and tramadol in comparison to codeine. A dose response study in human volunteers]

[Article in German]

Freye E, Rosenkranz B, Neruda B.

Abteilung fur Gefasschirurgie und Nierentransplantation, Medizinische Einrichtungen der Heinrich-Heine-Universitat, Moorenstrasse 5, D-40225 Dusseldorf.

Tramadol, a mixed mu-opioid agonist and a monoamine-reuptake blocking analgesic, has been supposed to have little effect on propulsive gastrointestinal motility. However, this has not been specifically studied in man. Following institutional approval, 18 human volunteers were given 50 mg of tramadol, tilidine/naloxone, and codeine, respectively, in a double-blind randomised cross-over design. Additionally, 12 further volunteers were given 100 mg of each opioid in a double-blind, randomised fashion, followed by measurement of gastrocoecal transit time. Gastrointestinal transit time was measured using the lactulose H(2)-breath test. A threefold increase in end-expiratory hydrogen when compared to the control value was considered the end point of gastrocoecal transit. At the low dose (50 mg) the three opioids did not differ significantly with regard to their effect on gastrointestinal motility. Gastrocoecal transit time was 90.8 (+/- 10.1 SEM) min for tramadol, 100.6 (+/- 9.8 SEM) min for tilidine/naloxone, and 104.2 (+/- 8.7 SEM) min for codeine. Doubling the dose of each opioid resulted in an increase in mean gastrocoecal transit, namely 97.8 (+/- 11.2 SEM) min for tramadol, 129.2 (+/- 12.2 SEM) min for tilidine/naloxone and 135.9 (+/- 9.2 SEM) min for codeine. The increase in gastrocoecal transit time was significant (P < 0.01) for high doses of tilidine/naloxone and codeine in contrast to the effect of the low doses. This lesser constipation effect may be due to the reduced affinity of tramadol to the mu-opioid receptor. Sedation was significantly higher for codeine after 50 mg (P < 0.05) and 100 mg (P < 0.005) tha



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