New Options for the Treatment of Fecal Incontinence

ABSTRACT

Fecal incontinence, the loss of anal sphincter control leading to the unwanted release of stool or gas, is a physical and psychological handicap that has a tremendous impact on an individual's quality of life. From a societal point of view fecal incontinence is the second most common caused of institutionalization in the United States. Although medical management is the mainstay of therapy for fecal incontinence, this review concentrates on invasive techniques, with a goal of highlighting newer technological and therapeutic advancements. The standard surgical treatment for fecal incontinence still remains direct sphincter repair with an overlapping sphincteroplasty, but this review concentrates specifically on biofeedback, the Procon incontinence device, local injection of synthetic materials, radiofrequency energy (Secca procedure), antegrade colonic enemas (ACE), sphincteroplasty, gluteoplasty, graciloplasty (both stimulated and nonstimulated), the artificial bowel sphincter, and sacral nerve stimulation.

KEYWORDS

Fecal incontinence - surgical techniques

REFERENCES

• 1 Borrie M J, Davidson H A. Incontinence in institutions.  CMAJ . 1992;  147 322-328
• 2 Johanson J F, Lafferty J. Epidemiology of fecal incontinence: the silent affliction.  Am J Gastroenterology . 1996;  91 33-36
• 3 Nelson R, Norton N, Cautley E, Furner S. Community-based prevalence of anal incontinence.  JAMA . 1995;  274 559-561
• 4 Perry S, Shaw C, McGrouther C. et al . Prevalence of faecal incontinence in adults aged 40 years or more living in the community.  Gut . 2002;  50 480-484
• 5 Engel B T, Nikoomanesh P, Schuster M N. Operant conditioning of the rectosphincteric responses in the treatment of faecal incontinence.  NEJM . 1974;  290 646-649
• 6 Norton C, HoskerG, Brazzelli M. Biofeedback and/or sphincter exercises for the treatment of faecal incontinence in adults (Cochrane Review). In: The Cochrane Library, Issue 1, 2003 Oxford: Update Software
• 7 Heyman S, Jones K R, Ringel Y. et al . Biofeedback treatment of fecal incontinence; a critical review.  Dis Colon Rectum . 2001;  44 728-736
• 8 Giamundo P, Welber A, Weiss E G. et al . The Procon incontinence device: a new nonsurgical approach to preventing episodes of fecal incontinence.  Am J Gastroenterol . 2002;  97 2328-2332
• 9 Shafik A. Perianal injection of autologous fat for the treatment of sphincteric incontinence.  Dis Colon Rectum . 1995;  38 583-587
• 10 Bernardi C, Favetta U, Pescatori M. Autologous fat injection for the treatment of fecal incontinence: manometric and echographic assessment.  Plast Reconstr Surg . 1998;  102 1626-1628
• 11 Kumar D, Benson M J, Bland J E. Gluteraldehyde cross-linked collagen in the treatment of faecal incontinence.  Br J Surg . 1998;  85 978-979
• 12 Shaik A. Polytetrafluorethylene injection for the treatment of partial faecal incontinence.  Int Surg . 1993;  78 159-161
• 13 Malouf A J, Vaizey C J, Norton C S, Kamm M A. Internal anal sphincter augmentation for fecal incontinence using injectable silicone biomaterial.  Dis Colon Rectum . 2001;  44 595-600
• 14 Kenefick N J, Vaizey C J, Malouf A J. et al . Injectable silicone biomaterial for faecal incontinence due to internal anal sphincter dysfunction.  Gut . 2002;  51 225-228
• 15 Weiss E J, Efron J, Nogueras J, Wexner S. Submucosal injection of carbon coated beads is a successful and safe office-based treatment of fecal incontinence.  Dis Colon Rectum . 2002;  45 A46
• 16 Efferon J, Corman M, Fleshman J. et al . Multicenter, open label, prospective trial evaluating the safety and effectiveness of temperature-controlled radiofrequency energy delivery to the anal canal (SECCA Procedure) for the treatment of fecal incontinence.  Dis Colon Rectum . 2002;  45 A24
• 17 Takahashi T, Garcia-Osogobio S, Valadovinos. et al . Radio-frequency energy delivery to the anal canal for the treatment of fecal incontinence.  Dis Colon Rectum . 2002;  45 915-922
• 18 Dalby S W. Opening the cecum for intestinal obstruction (Report of the Medical Society of London) Br Med J .  1894;  17 12
• 19 Keetley C B. Appendicostomy.  Br Med J . 1905;  7 863-865
• 20 Wheeler R A, Malone P S. Use of the appendix in reconstructive surgery: a case against incidental appendectomy.  Br J Surg . 1991;  78 1283-1285
• 21 Williams N S, Hughes S F, Stuchfield B. Continent colonic conduit for rectal evacuation in severe constipation.  Lancet . 1994;  343 1321-1324
• 22 Chetwood C H. Plastic operation for restoration of the sphincter ani with report of a case.  Med Rec . 1902;  61 529
• 23 Devesa J M, Vicente E, Enriquez J M. et al . Total fecal incontince: a new method of gluteus maximus transposition: preliminary results and report of previous experience with similar procedures.  Dis Colon Rectum . 1992;  35 339-349
• 24 Pak-art R, Silapunt P, Bunapraser T. et al . Prospective, randomized, controlled trial of proximally based versus distally based gluteus maximus flap for anal incontinence in cadavers.  Dis Colon Rectum . 2002;  45 1100-1103
• 25 Devesa J M, Madrid J M, Gallego B R. et al . Bilateral gluteoplasty for fecal incontinence.  Dis Colon Rectum . 1997;  40 883-888
• 26 Pickrell K L, Broadbent T R, Masters F W. et al . Construction of a rectal sphincter and restoration of anal continence by transplanting the gracilis muscle: a report of four cases in children.  Ann Surg. 1952;  135 853-862
• 27 Salmons S, Henriksson J. The adapive response of skeletal muscle to increased use.  Muscle Nerve . 1981;  4 94-105
• 28 Baeten C G, and the Dynamic Graciloplasty Therapy Study Group. Safety and efficacy of dynamic graciloplasty for fecal incontinence.  Dis Colon Rectum . 2000;  43 743-751
• 29 Wexner S D, Baeten C G, Bailey H R. et al . Long-term efficacy of dynamic graciloplasty for fecal incontinence.  Dis Colon Rectum . 2002;  45 809-818
• 30 Matzel K E, Madoff R D, LaFontaine L J. et al . Complications of dynamic graciloplasty.  Dis Colon Rectum . 2001;  44 1427-1435
• 31 Lehur P A, Zerbi F, Neunlist M. et al . Comparison of quality of life and anorectal function after artificial sphincter implantation.  Dis Colon Rectum . 2002;  45 508-513
• 32 Altomare D F, Dodi G, LaTorre F. et al . Multicentre retrospective analysis of the outcome of artificial anal sphincter implantation for sever faecal incontinence.  Br J Surg . 2001;  88 1481-1486
• 33 Michot F, Costaglioli B, Leroi A, Denis P. Artificial anal sphincter in severe fecal incontinence: outcome of prospective experience with 37 patients in one institution.  Ann Surg . 2003;  237 52-56
• 34 Wong W D, Congliosi S M, Spencer M P. et al . The safety and efficacy of the artificial bowel sphincter for fecal incontinence; results of a multicenter cohort study.  Dis Colon Rectum . 2002;  45 1139-1153
• 35 Malouf A J, Vaizey C J, Nicholls R J, Kamm M A. Permanent sacral nerve stimulation for fecal incontinence.  Ann Surg . 2000;  232 143-148
• 36 Ganio E, Realis Luc A, Clerico G, Trompetto M. Sacral nerve stimulation for the treatment of fecal incontinence: a novel approach for intractable fecal incontinence.  Dis Colon Rectum . 2001;  44 619-631