SusanC. Parker

Publications (2)6.26 Total impact

• Article: Artificial Bowel Sphincter

  SusanC. Parker, MichaelP. Spencer, RobertD. Madoff, LindaL. Jensen, W.Douglas Wong, DavidA. Rothenberger
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  ABSTRACT: PURPOSE: This study was undertaken to evaluate a single-institution experience with the Acticon artificial bowel sphincter for the treatment of intractable fecal incontinence. METHODS: At the University of Minnesota, 45 consecutive patients underwent artificial bowel sphincter placement (Group I, 1989–1992, n = 10; Group II, 1997–2001, n = 35). Group I was reviewed retrospectively and Group II prospectively. RESULTS: The outcome for Group I patients was initially reported in 1995 (mean age, 32; range, 15–52 years; 7 males). Of these 10 patients, 4 required explantation (2 required stomas), and 6 have a functional artificial bowel sphincter; 2 patients had devices successfully replaced for fluid leaks (at 6 and 10 years). In Group II, artificial bowel sphincter placement was attempted in 37 patients and was successful in 35 (mean age, 47; range, 18–72 years; 11 males). A total of 14 patients required explantation, 12 (34 percent) for infection and 2 (6 percent) for pain. In total, 13 patients have required 21 revisions, including 7 complete device replacements. The infection rate for revisions was 19 percent; four patients required explantation after revisions. Of 18 patients whose artificial bowel sphincter failed, 9 required a stoma. In all, 17 (49 percent) patients have a functional artificial bowel sphincter. In Group II fecal incontinence severity scores decreased from a mean of 103 preimplant to 59 at one year and to 23 at two or more years (P < 0.001) in patients who retained their devices. Quality of life scores improved in all patients at six months and at one year (P < 0.01). CONCLUSION: Artificial bowel sphincter therapy leads to long-term improved continence and quality of life in patients whose implantation is successful. Success rates have not improved in the two patient groups, with infection remaining a major challenge. However, once successfully established, artificial bowel sphincter function remains stable for many years.
  Diseases of the Colon & Rectum 05/2003; 46(6):722-729. · 3.13 Impact Factor
• Article: Quality of Life After Subtotal Colectomy for Slow-Transit Constipation

  GregoryP. FitzHarris, Julio Garcia-Aguilar, SusanC. Parker, KelliM. Bullard, RobertD. Madoff, StanleyM. Goldberg, Ann Lowry
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  ABSTRACT: PURPOSE: Subtotal colectomy reliably increases bowel-movement frequency in patients with slow-transit constipation, but its impact on quality of life is unknown. The purpose of this study was to assess the relationship between functional outcomes and quality of life after subtotal colectomy for slow-transit constipation. METHODS: We reviewed the charts and operative reports of all patients who underwent subtotal colectomy for slow-transit constipation from January 1992 to June 2001. We sent them a 54-question survey that inquired about bowel function and included a modified 36-item gastrointestinal quality-of-life index. Using Pearsons R, we correlated gastrointestinal quality-of-life index scores with specific functional outcomes. RESULTS: Of 112 patients (109 females), 28 had been lost to follow-up and 2 had died. In all, 75 surveys (67 percent) were returned. Most of these 75 patients (81 percent) were at least somewhat pleased with their bowel-movement frequency, but 41 percent cited abdominal pain; 21 percent, incontinence; and 46 percent, diarrhea at least some of the time. The overall mean gastrointestinal quality-of-life index score was 103 22 of a maximum possible score of 144 (mean score for healthy controls, 126 13). We found no correlation between frequency of bowel movements and gastrointestinal quality-of-life index score (R = –0.03). Abdominal pain, diarrhea, and incontinence each had a statistically significant negative impact on gastrointestinal quality-of-life index scores (P = 0.01). Patients who required permanent ileostomy had low gastrointestinal quality-of-life index scores (68 24). The vast majority (93 percent) of patients stated they would undergo subtotal colectomy again if given a second chance. CONCLUSION: Subtotal colectomy for slow-transit constipation increases bowel-movement frequency; however, the persistence of abdominal pain and the development of postoperative incontinence or diarrhea adversely affect quality of life. Although most patients in the present study were satisfied with their results, quality-of-life scores should be used to assess postoperative outcome.
  Diseases of the Colon & Rectum 03/2003; 46(4):433-440. · 3.13 Impact Factor