PERFORMING THE NEW SECCA PROCEDURE FOR BOWEL INCONTINENCE
As many as 1 of 13 adults in the United States suffers from problems with bowel control, also called fecal incontinence. Fecal incontinence is the involuntary leakage of stool or gas from the anal canal. There are many causes of this disorder, and in many cases several factors may combine to cause fecal incontinence.
Management of fecal incontinence is provided in a tiered approach, beginning with lifestyle modification or pharmacologic therapy followed by selectively offering biofeedback and surgery to eligible patients. However, because of failure of conservative therapies, and ineligibility for surgery, many patients are left with no treatment options.
The Secca procedure is a new option for patients who have failed conservative therapies and desire a less invasive option than surgery.
This non-surgical procedure involves delivery of radiofrequency energy to the muscles of the anal canal, which causes tissue shrinkage and tightening. The procedure takes about 45 minutes, does not require general anesthesia, and patients can generally go home 1-2 hours after the procedure.
Marvin L. Corman, MD, professor of surgery, is skilled at performing the new Secca procedure, as well as the latest surgical operations to treat bowel incontinence.
Dr. Corman participated in a multicenter study of the Secca procedure. "In our study of 50 patients," he says, "mean duration of fecal incontinence was nearly 15 years. The Secca procedure significantly improved the quality of life for most patients who underwent the procedure."
For consultations/appointments with Dr. Corman, please call 631-444-4545 or 631-444-1793.
Safety and effectiveness of temperature-controlled radio-frequency energy delivery to the anal canal (Secca procedure) for the treatment of fecal incontinence|
Purpose: This multicenter study evaluated the safety and efficacy of radio-frequency energy delivery to the anal canal for the treatment of fecal incontinence.
Methods: Fifty patients at five centers were enrolled. All reported fecal incontinence at least once per week for three months, and medical and/or surgical management failed to help their symptoms. At baseline and at six months, patients completed questionnaires (Cleveland Clinic Florida Fecal Incontinence score (0-20), fecal incontinence-related quality of life, Short Form-36, and visual analog scale) and underwent anorectal manometry, endoanal ultrasound, and pudendal nerve terminal motor latency testing. On an outpatient basis using local anesthesia, radio-frequency energy was delivered via an anoscopic device with multiple needle electrodes (Secca system) to create thermal lesions deep to the mucosa of the anal canal.
Results: Forty-three females and seven males (aged 61.1 ± 13.4 (mean ± standard deviation); range, 30-80 years) were treated. Mean duration of fecal incontinence was 14.9 years. Treatment time was 37 ± 9 minutes. At six months, the mean Cleveland Clinic Florida Fecal Incontinence score improved from 14.5 to 11.1 (P < 0.0001). All parameters in the Fecal Incontinence Quality of Life scales were improved (lifestyle (from 2.5-3.1; P < 0.0001); coping (from 1.9-2.4; P < 0.0001), depression (from 2.8-3.3; P = 0.0004); embarrassment (from 1.9-2.5; P < 0.0001)). Responders, as assessed by a systematic referenced analog scale, reported a median 70 percent resolution of symptoms. The mean Short Form-36 social function improved from 64.3 to 76 (P = 0.003). There were no changes in endoanal ultrasound or pudendal nerve terminal motor latency assessment, or in anal manometry. Complications included mucosal ulceration (one superficial, one with underlying muscle injury) and delayed bleeding (n = 1).
Conclusion: This multicenter trial demonstrates that radio-frequency energy can be safely delivered to the lower rectum and anal canal. The Secca procedure significantly improved the Cleveland Clinic Florida Fecal Incontinence score and the overall quality of life for most patients having undergone the procedure.
Efron JE, Corman ML, Fleshman J, et al. Safety and effectiveness of temperature-controlled radio-frequency energy delivery to the anal canal (Secca procedure) for the treatment of fecal incontinence. Dis Colon Rectum 2003;46:1606-18.
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