8,89±1,7; p< 0,05), after physiotherapy and follow up (GI: 8,35±1,6 vs. 8,01±2,1; p<0,05),(FI: 8,89±1,7 vs. 8,2±2,0; p<0,05). Results from VAS obtained following physiotherapyshow evidence of a better defecation control. Group II: manometry performed on patientswith PFD showed no differences in resting (55,00 ± 13,7 vs. 58,9 ± 23,5; p<0,05) andsqueeze pressure (139,7±33,9 vs. 120,75±53,4; p<0,05). There were no differences in rectalsensation. Statistically significant changes were observed during push effort (73,7±34,4 vs.36,9 ± 19,4; p<0,05) and length of HPZ (3,1±0,8 vs. 2,5± 0,7; p<0,05). VAS showed asignificant increase as compared to initial values defined as higher frequency of defecation(0,00 ± 0 vs. 7,25 ± 2,99). The improvements are still observed during follow up (6,97±2,9vs. 7,25±2,9; p<0,02). Conclusion: The designed physiotherapy program has been provedto be effective in patients with FI and PFD. The improvement of defecation control andanorectal function in patient with fecal incontinence and dyssynergic defecation - both inshort and long term follow-up, has been obtained.

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Overt Rectal Prolapse in MaleLaurent Siproudhis, Laurent Siproudhis, Veronique Desfourneaux, Guillaume Bouguen,Caroline Couffon, Isabelle Berkelmans, Jean-François Bretagne

Overt rectal prolapse (PR) in male is uncommon and it is rarely reported. The aim of ourstudy was to clarify both symptoms and surgical strategies. Patients and methods: between2003 and 2009, 270 consecutive patients (average age: 58.2±17.9 years) have been referred ina tertiary centre before surgery for PR. Symptomatic data were collected by self-administeredquestionnaires before and after therapeutic intervention (39.4±26.9 months), and physiologyincluded anorectal manometry, defecography and anal endosonography. Database and collec-tion were approved by the ethical committee (CNIL, the ethics committee). Data of the malegroup were compared to those recorded in age- and PR- (anatomical level) matched groupof women. Result: Twenty-six men (9.6%) were referred before surgery after a mean symptomduration of 52 ± 56.7 months. The main complaint was prolapse, urgency and rectalincontinence in respectively 8, 6 and 4 cases. Incontinence was present in 17 (65%) andpassive leakage was reported in 15 cases. Surgical treatment was realized in 15 patients (13laparoscopic rectopexy) of 26 after an average follow-up (40.2±26 months). Compared tothe entire study population, men were significantly younger (43±18 vs. 60±17, p <0.0001),but the past history, presentation, and symptom scores surgery were not statistically different.As compared to the matched group, anal physiology, sphincter endosonography and pelvicfloor disorders (defecography) were not different between groups. After treatment, thesatisfaction levels and changes in symptom scores did not differ between groups. Conclusion:Although the occurrence of RP in male is a rare event, either symptomatic and physiologicaldata or therapeutic management do not differ from those observed in women

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Predicting Changes in Anal Sphincter Physiology Following Lay Open of AnalFistulaAlexis M. Schizas, Anton V. Emmanuel, Andrew B. Williams

Introduction Anal fistula are a common surgical problem affecting 8.6 cases per 100000people. Laying open of the fistula track remains the best option with the highest rates ofsuccess and lowest recurrence rates than any other treatment option. However division ofthe anal sphincters may lead to a deterioration in continence. There are currently no availableinvestigations to predict changes in anal sphincter function following lay open of an analfistula. This study aims to pre-operatively predict changes in sphincter function followingfistulotomy by correlating anal endosonography (AES) and vector volume (VV). MethodPatients awaiting surgery for anal fistula were recruited into the study. AES and VV wereperformed pre and post-operatively along with the St Mark's faecal incontinence question-naire. The site of the internal opening in the anal canal was identified on AES and thecranio-caudal distance from the anal verge was measured. This was then correlated withthe VV to show the physiology of the anal canal above and below the site of the internalopening. The pre and post operative information was analysed to identify any possibility inpredicting post-operative changes in sphincter function after fistulotomy. Results 23 patientswith intersphincteric fistula were recruited. There was only a fall in resting vector volumefollowing intersphincteric fistulotomy. Analysis of the various vector manometry parametersand anal endosonographic measurements were performed but there was no obvious patternor correlation to predict the changes in post-operative resting pressure. 14 patients withtranssphincteric fistula were recruited. There was a fall in both resting and squeeze vectorvolumes following transsphincteric fistulotomy. There were several patterns seen allowingfor accurate prediction of post-operative VV from the pre-operatively synchronised AES andVV. These are summarised in the table 1. There was a correlation between the post-operativeSt Mark's faecal incontinence score and the post-operative squeeze vector volume (p = 0.03)and maximum squeeze pressure (p = 0.01). As faecal incontinence is dependent on bothrest and squeeze anal function, analysis was performed between faecal incontinence andrest plus squeeze. The post operative St Mark's was found to correlate with the post operativerest plus squeeze (p =0.05). Conclusions For the first time a correlation of AES and VVenables accurate predictions of post-operative VV from the pre-operative investigations. Itwas also possible to predict the changes in maximimum and average anal canal pressures.Correlation was also identified between sphincter function and St Mark's faecal incontin-ence scores.Table 1. Post-operative vector volume prediction equations.

S-801 AGA Abstracts

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Anorectal Motility and Life Quality After Conventional Versus SphincterSparing Anal Fistula TreatmentRoman M. Herman, Michal Nowakowski, Jakub Kucharz, Roma B. Herman

Background & Aims. Conventional surgical treatment -fistulectomy(CFT)) of Transsphinc-teric Anal Fistulas (TAF) frequently resulted in anal sphincter insufficiency leading to fecalincontinence(FI). Noninvasive fistula treatment -Anal Fistula Pflug (AFP)has been proposedto reduce complication and to preserve anal sphincter function. Study was designed toevaluate anorectal motility ,fecal continence and life quality in TAF patients underwent CFTand AFP. Patients & Methods : 58 patients (36 male, 22 female) with TAF underwentconventional - 32 pts vs noninvasive- 26 pts treatment . Pre- and post-operative (one year)evaluation included: clinical results( complication, healing time), anorectal manometry , 48-channel surface EMG(s-EMG), transanal ultrasound (TAUS), incontinence index (CCF-FI)and life quality (FIQoL). Results : Postoperative complication appeared in 3/22(13,6%)AFP pts , and 8/36(22,2%) CFT pts , mean fistula healing time was significantly longer inCFT vs AFP ( 16 vs 6 weeks).Postoperatively Resting (RAP) and Squeeze Anal Pressure(SAP) decreased significantly in CFT pts (RAP: 46,6 to 36,4 ; SAP: 96,8 to 76,4mmHg ).EMG revealed impaired EAS function (innervations) in 50% of CFT and 10% AFP pts .TAUSshoved marked sphincter defects in 18 /32 (56%)CFT and 4/26(15 %) AFP pts. CFT patientsfrequently complains of FI symptoms: CCF-FI in CFT group increased from 6,1 to 10,6 ascompared to AF group(5,8-6,4)).FIQoL: 80 % of CFT patients revealed impaired life qualityin 3 of 4 studied domains as compared to AFT (1 of 4 domains in 30 % pts). Conclusion:Noninvasive anal fistula treatment using Anal Fistula Pflug is safe and effective treatmentpreserving anal sphincter function and improving life quality. Conventional surgical treat-ment-fistulectomy-shoved longer healing time and high rate of complication, significantlyinfluencing anorectal function and patients life quality.(Grant No 1837/B/P01/2008:PolishMinistery of Science and Higher Education)

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Clinical Efficacy of Sensorimotor Response in Anorectal Manometry: A SingleCenter Study Based on Cohort PatientsKee Wook Jung, Seung-Jae Myung, Dong-Hoon Yang, Ashley Ha, In ja Yoon, So youngSeo, Hyun Sook Koo, Yong Gil Kim, Bong-Jun Han, Ock Bae Ko, Kyung Jo Kim, ByongDuk Ye, Jeong-Sik Byeon, Hwoon-Yong Jung, Suk-Kyun Yang, Jin-Ho Kim

Background: Sensorimotor response (SMR) has been suggested as one of key physiologicalparameters in anorectal manometry (ARM). However, its validity and clinical efficacy havenot yet been fully evaluated in large number of patients. Moreover, previous studies commonlyused solid catheters, and SMR has not been validated in studies using water-perfusion system,which is more popular in present days. We aimed to investigate the clinical efficacy andvalidity of SMR based on a cohort of patients. Methods: From February to June 2009, thepatients who underwent ARM with a specialized 9-channel balloon catheter in Asan MedicalCenter, Seoul, Korea were enrolled in this study. SMR was defined as a transient, analcontractile response that occurred overlying the rectoanal inhibitory reflex (RAIR). Weanalyzed the correlation between SMR and parameters of ARM including desire-to-defecatevolume (DDV) or urge-to-defecate volume (UDV). Also, the correlation of SMR to DDV orUDV wasmonitored before and after biofeedback therapy (BFT) to elucidate the reproducibil-ity of these findings. Results: A total of 104 patients (M:F = 35:69, mean age = 58 ± 13years) were identified as a study population. Ninety eight out of 104 patients (94.2%)showed definite SMR. Their SMR was significantly different from RAIR (11.84 ± 5.24 mmHgin RAIR vs. 85.10 ± 38.64 mmHg in SMR, P<0.01). Among them, 66 out of 98 SMRs(67.3%) were correlated with DDV (77.58 ± 40.35 mmHg). The other 32 SMRs (32.7%)were correlated with UDV (100.63 ± 29.83 mmHg). DDV group showed faster onset ofSMR than the UDV group (10.73 ± 0.61 sec in DDV vs. 13.36 ± 0.88 sec in UDV, P =0.02). However, in other parameters including amplitude (16.57 ± 2.60 mmHg in DDV vs.33.40 ± 3.74 in UDV, P = 0.14) and duration (7.00 ± 0.57 sec in DDV vs. 8.09 ± 0.82 secin UDV, P = 0.27) of SMR, there was no significant difference between two groups. Amongthe patients with SMR, 10 patients (M:F = 5:5, mean age = 61 ± 12 yrs) underwent subsequentARM after BFT. SMR was consistently correlated with DDV (n = 7) or UDV (n = 3) afterBFT, although their DDV and UDV decreased significantly after BFT. Conclusions: SMRwas found to exist in water-perfused catheter system. SMRs were correlated with DDV inconsiderable proportion of the individuals and SMR was consistently correlated with DDVor UDV even after BFT suggesting SMR could serve as an objective parameter with regardto BFT response.

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Factors Associated With Severity of Fecal Incontinence: A Study of PatientCharacteristics and Fecal Incontinence Severity Index (FISI)Stacy B. Menees, Tovia M. Smith, Xiao Xu, William D. Chey, Richard J. Saad, Dee Fenner

Objectives: Fecal incontinence (FI) may affect up to 25% of the U.S. population. Identifyingfactors that are associated with worsening symptoms has important implications for preven-tion and treatment. The aim of our study was to evaluate the subjects' presenting stool typeon the Bristol stool scale (1-7) and to assess how this correlated with worsening symptomson the fecal incontinence severity index (FISI) Methods: 251 patients followed in theMichiganBowel Control Program Clinic were prospectively enrolled between 5/2005 and 5/2009. Atinitial visit, each patient completed a questionnaire addressing severity of fecal incontinencegathering information on demographics, past history and concurrent symptoms. Severity ofincontinence was measured using the fecal incontinence severity index (FISI). Statistics werecalculated for patient characteristics. Bivariate analysis with single linear regression wasperformed. All variables that were significant (p<.05) were included in the multiple linearregression analysis. P values less than 0.05 were considered statistically significant. Results:The mean age of the sample was 58.9 years (SD=14.7) and the BMI was 29.9 (SD=8.4).Subjects were predominantly female (92%), Caucasian (92%) and married (66.5%). MeanFISI score was 31.6. Bristol stool types 3 & 5 were the most common reported at 27% and

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