Treatment options for fecal incontinenceSurgical treatment options for fecal incontinence
Section snippets
Overlapping sphincter repair (sphincteroplasty)
There is general agreement that overlapping sphincter repair is appropriate first-line therapy for incontinent individuals with significant sphincter defects. However, there have been no randomized trials comparing sphincteroplasty with nonsurgical therapies such as biofeedback. Table 1 shows the results of sphincteroplasty series reported since 1984 that included at least 30 patients.3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15 Varying definitions notwithstanding, approximately two thirds of
Muscle transfer procedures
Pickrell et al. described the use of gracilis transposition to function as a neosphincter in 1952,27 and Corman reported good results with passive gracilis wraps in 1985.28 More recently, Faucheron et al. confirmed that a significant number of patients improve with passive gracilis wraps alone.29 Less common alternatives for passive muscle neosphincters include bilateral nonstimulated graciloplasty30 and bilateral gluteus maximus transposition.31, 32, 33
Dynamic graciloplasty (the addition of
Artificial anal sphincter
The artificial anal sphincter represents an alternate approach to dynamic anal sphincter replacement. Like the dynamic graciloplasty, the artificial anal sphincter is placed around the native sphincter via perianal tunnels. The device remains inflated until the patient wishes to defecate, at which time the device is deactivated by a manual pump implanted in the scrotum or labia majora. The current device (Acticon Neosphincter; American Medical Systems, Minnetonka, MN) and its precursor (AMS
Sacral nerve stimulation
Sacral nerve stimulation, originally developed for urinary voiding dysfunction, has been used to successfully manage fecal incontinence. Matzel et al. first reported this technique in 1995.50 Vaizey et al. evaluated sacral nerve stimulation in 12 patients treated for 1 week with percutaneous leads and external pulse generators.51 Of the 9 evaluable patients (3 had early lead dislodgments), 7 became fully continent and one improved markedly.
There are relatively few reports on the results of
Conclusion
Patients with fecal incontinence now have several surgical options for treating the disorder. Ironically, the most established approach, overlapping sphincteroplasty, has been subject to the least stringent study protocols. Newer competing therapies are now being studied prospectively with diary data and validated quality-of-life instruments. However, experience with novel therapies remains limited and must be expanded before their proper role in incontinence management can be defined.
Important
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