{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,25]],"date-time":"2026-06-25T06:01:43Z","timestamp":1782367303484,"version":"3.54.5"},"reference-count":27,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2021,1,22]],"date-time":"2021-01-22T00:00:00Z","timestamp":1611273600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2021,1,22]],"date-time":"2021-01-22T00:00:00Z","timestamp":1611273600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/www.springer.com\/tdm"},{"start":{"date-parts":[[2021,1,22]],"date-time":"2021-01-22T00:00:00Z","timestamp":1611273600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/www.springer.com\/tdm"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["World j. surg."],"published-print":{"date-parts":[[2021,4]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Treatment of anismus usually starts with biofeedback therapy and injection of botulinum toxin in the puborectalis muscle (PRM). Patients refractory to conservative treatment may require surgery. The present cohort study aimed to assess a combined technique of partial division of PRM and tailored lateral internal sphincterotomy (LIS) in treatment of anismus.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Patients with anismus who failed conservative treatments were assessed clinically and with high\u2010resolution anal manometry (HRAM), EMG, defecography, and underwent combined partial division of PRM on one side and tailored LIS on the contralateral side. Main outcome measures were improvement in symptoms and quality of life, changes in HRAM and defecography postoperatively, complications, and patient satisfaction.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 73 patients (61\u00a0male) of a mean age of 37 years were included to the study. In total, 89% of patients showed a significant improvement in symptoms at 12\u00a0months postoperatively. The mean modified Altomare score decreased significantly (<jats:italic><jats:styled-content>p<\/jats:styled-content><\/jats:italic> &lt; 0.0001) from 16.4 \u00b1 1.7 to 6.6 \u00b1 1 at 12\u00a0months postoperatively. There was a significant increase in the mental and physical components of quality of life at 12\u00a0months postoperatively. The numbers of patients with positive findings of anismus in postoperative defecography, EMG, and balloon expulsion test were significantly less than before surgery. The mean total satisfaction score was 86.5 \u00b1 8.7. Five (6.5%) patients developed minor complications.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Partial division of puborectalis muscle combined with LIS is an effective technique in the management of anal hypertonia\u2010associated anismus with satisfactory results and low incidence of complications<\/jats:p><\/jats:sec>","DOI":"10.1007\/s00268-020-05919-y","type":"journal-article","created":{"date-parts":[[2021,1,22]],"date-time":"2021-01-22T16:07:55Z","timestamp":1611331675000},"page":"1210-1221","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Partial Division of Puborectalis Muscle with Lateral Internal Sphincterotomy: A Novel Surgical Technique for Management of Anal Hypertonia\u2010Associated Anismus"],"prefix":"10.1002","volume":"45","author":[{"given":"Mahmoud","family":"Abdelnaby","sequence":"first","affiliation":[{"name":"General Surgery Department, Mansoura University Hospitals Mansoura University 60 El\u2010Gomhouria Street 35516 Mansoura Dakahlia Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammad","family":"Fathy","sequence":"additional","affiliation":[{"name":"General Surgery Department, Mansoura University Hospitals Mansoura University 60 El\u2010Gomhouria Street 35516 Mansoura Dakahlia Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hany Maurice","family":"Mikhail","sequence":"additional","affiliation":[{"name":"General Surgery Department, Qasr Al\u2010Ainy Hospitals Cairo University Cairo Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karim Kamal","family":"Maurice","sequence":"additional","affiliation":[{"name":"General Surgery Department, Qasr Al\u2010Ainy Hospitals Cairo University Cairo Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamed","family":"Arnous","sequence":"additional","affiliation":[{"name":"General Surgery Department, Mansoura University Hospitals Mansoura University 60 El\u2010Gomhouria Street 35516 Mansoura Dakahlia Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sameh Hany","family":"Emile","sequence":"additional","affiliation":[{"name":"General Surgery Department, Mansoura University Hospitals Mansoura University 60 El\u2010Gomhouria Street 35516 Mansoura Dakahlia Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2021,1,22]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph16183247"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.4292\/wjgpt.v7.i3.453"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cgh.2017.10.027"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0016\u20105085(16)30626\u20106"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.5056\/jnm.2010.16.4.437"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.5056\/jnm16060"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF02616902"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF02617812"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1002\/bjs.1800720623"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1002\/bjs.1800750713"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF02054442"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11605\u2010009\u20100931\u20106"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.7326\/0003\u20104819\u2010147\u20108\u2010200710160\u201000010"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11894\u2010017\u20100554\u20100"},{"issue":"1","key":"e_1_2_8_16_1","first-page":"57","article-title":"Scoring systems in evaluation of constipation and obstructed defecation syndrome (ODS)","volume":"25","author":"Sharma S","year":"2012","journal-title":"JIMSA January\u2013March"},{"key":"e_1_2_8_17_1","doi-asserted-by":"publisher","DOI":"10.1097\/00005650\u2010199603000\u201000003"},{"key":"e_1_2_8_18_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00384\u2010015\u20102330\u20107"},{"key":"e_1_2_8_19_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF02050307"},{"key":"e_1_2_8_20_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.sla.0000133083.54934.ae"},{"key":"e_1_2_8_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jmig.2011.08.171"},{"key":"e_1_2_8_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2007.12.036"},{"key":"e_1_2_8_23_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00268\u2010007\u20109177\u20101"},{"key":"e_1_2_8_24_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10151\u2010005\u20100210\u20109"},{"key":"e_1_2_8_25_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00384\u2010008\u20100609\u20107"},{"key":"e_1_2_8_26_1","doi-asserted-by":"publisher","DOI":"10.5056\/jnm16060"},{"key":"e_1_2_8_27_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF02234795"},{"key":"e_1_2_8_28_1","doi-asserted-by":"publisher","DOI":"10.1111\/codi.12108"}],"container-title":["World Journal of Surgery"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1007\/s00268-020-05919-y.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/article\/10.1007\/s00268-020-05919-y\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1007\/s00268-020-05919-y.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1007\/s00268-020-05919-y","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,1,7]],"date-time":"2024-01-07T17:50:11Z","timestamp":1704649811000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1007\/s00268-020-05919-y"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,1,22]]},"references-count":27,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2021,4]]}},"alternative-id":["10.1007\/s00268-020-05919-y"],"URL":"https:\/\/doi.org\/10.1007\/s00268-020-05919-y","archive":["Portico"],"relation":{},"ISSN":["0364-2313","1432-2323"],"issn-type":[{"value":"0364-2313","type":"print"},{"value":"1432-2323","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,1,22]]},"assertion":[{"value":"9 December 2020","order":1,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"22 January 2021","order":2,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Compliance with ethical standards"}},{"value":"None to be disclosed by the authors","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interests"}}]}}