The MFA: a new device for early patients

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
cant 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 hell 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-hypersensiti
vity 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 proctologists
decision to utilize one or two staplers for the
prolapse resection. Thats also useful in
compiling the consent form. 4) Length Measurement
of Anal Canal (LMAC) Fig 4 Its 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 theres a
clear correlation between rectal-hypersensitivity,
DU and SDU (plt0.001). Fig. 8
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Discussion
References
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