EP470 - Analysis of the Incidence of Pelvic Floor Disorders in Patients Undergoing Bariatric Surgery: A Prospective Study

Purpose/Background: High-resolution anorectal electromanometry was employed in this study to evaluate the functional status of the anorectal region in patients who have undergone bariatric surgery. This technique allows for the assessment of various manometric parameters, including resting pressure, contraction pressure, rectoanal reflex, rectal sensitivity, and anal canal pressure during straining. By analyzing these parameters, this study aims to identify anorectal complaints and understand the impact of bariatric surgery on pelvic floor function, contributing to a better understanding of potential complications and guiding preventive approaches for patients.

Methods/Interventions: This prospective study was conducted from January 2020 to July 2025 and involved 58 patients at a clinic who underwent bariatric surgery, assessed using high-resolution anorectal electromanometry for anorectal complaints. The data evaluated included age, sex, time since surgery, clinical data, parity, and the type of bariatric surgery (sleeve or bypass). The manometric parameters assessed included anal canal length (cm), resting pressure (mmHg), contraction pressure (mmHg), sustained contraction pressure (%), rectoanal reflex, rectal sensitivity (ml), rectal capacity (ml), intra-rectal pressure during straining, and anal canal pressure during evacuatory efforts. The type of pelvic floor disorder was assessed according to Rao, along with the rectoanal reflex.

Results/Outcomes: The mean age of participants was 40.52 years (range: 25-75), with 10 being male. Among the women, 22 were nulliparous and 42 had at least one child (14 by vaginal delivery and 28 by cesarean section). The primary complaint among patients was constipation or difficulty in bowel evacuation, reported by 29 patients, while 14 patients reported fecal incontinence. Additionally, 15 patients experienced anal pain. The mean anal canal length was 3.58 cm (range: 0.7-5.2). The mean resting pressure was 70.01 mmHg (range: 11-127 mmHg), and the mean contraction pressure was 79.37 mmHg (range: 2-223 mmHg). The mean rectal sensitivity threshold was 50 ml (range: 20-100), the threshold for the urge to evacuate was 76 ml (range: 30-180), and the mean rectal capacity was 169 ml (range: 11-400).

The most prevalent type of pelvic floor disorder found in high-resolution manometry was type II according to Rao (33 patients), followed by type I (4), type III (0), and type IV (10). Eleven patients did not present pelvic floor dyssynergia. The rectoanal reflex was present in 42 patients, absent in 1, and indeterminate in 15.

Statistical analysis compared patients who underwent sleeve and bypass bariatric surgery using the Student's t-test for resting pressure (p = 0.141) and contraction pressure (p = 0.0272). The majority of patients in both groups presented constipation as the primary clinical complaint (43.75% in the sleeve group vs. 52.38% in the bypass group), followed by anal pain and fecal incontinence. The highest prevalence of pelvic floor dyssynergia was type II in both groups (47% in the sleeve group vs. 60% in the bypass group).

Conclusion/Discussion: This study emphasizes the need to be aware of potential pelvic floor disorders and anorectal symptoms, such as constipation, anal pain, and fecal incontinence, in patients undergoing surgery for obesity treatment. These findings underscore the importance of monitoring and addressing these complications to improve patient outcomes and quality of life.