Fecal incontinence surgery
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Surgery
Surgical procedures used to treat otherwise intractable fecal incontinence include:
- Stimulated graciloplasty creates a new anal sphincter, using gracilis muscle from the thigh and a temporary electric device to retrain the muscle for its new function.
- Artificial anal sphincter (also known as "artificial bowel sphincter" and "neosphincter").[1] The usual surgical approach is through the perineum but because in many cases of fecal incontinence the perineum is damaged, for women an alternative approach is through the vagina.[2]
- Temperature-controlled radiofrequency energy (SECCA)[3]
- Antegrade continent enema stoma. This procedure is often necessary in addition to others when fecal incontinence is complicated by neuropathy and/or an incomplete internal anal sphincter.
- Sacral nerve stimulation, the newest of these surgical procedures, involves implanting an electric device that may enable control of the anal sphincter and restore a patient's continence.[2]
Graciloplasty and artificial anal sphincter both significantly improve continence, with artificial anal sphincter being superior,[4] however both methods have high rates of complications.[4][5]
References
- ↑ Schrag HJ, Ruthmann O, Doll A, Goldschmidtböing F, Woias P, Hopt UT (2006). "Development of a novel, remote-controlled artificial bowel sphincter through microsystems technology". Artif Organs. 30 (11): 855–62. doi:10.1111/j.1525-1594.2006.00312.x. PMID 17062108.
- ↑ Michot F, Tuech JJ, Lefebure B, Bridoux V, Denis P (2007). "A new implantation procedure of artificial sphincter for anal incontinence: the transvaginal approach". Dis. Colon Rectum. 50 (9): 1401–4. doi:10.1007/s10350-007-0314-6. PMID 17665251.
- ↑ Felt-Bersma RJ, Szojda MM, Mulder CJ (2007). "Temperature-controlled radiofrequency energy (SECCA) to the anal canal for the treatment of faecal incontinence offers moderate improvement". Eur J Gastroenterol Hepatol. 19 (7): 575–80. doi:10.1097/MEG.0b013e32811ec010. PMID 17556904.
- ↑ 4.0 4.1 Ruthmann O, Fischer A, Hopt UT, Schrag HJ (2006). "[Dynamic graciloplasty vs artificial bowel sphincter in the management of severe fecal incontinence]". Chirurg (in German). 77 (10): 926–38. doi:10.1007/s00104-006-1217-0. PMID 16896900.
- ↑ Belyaev O, Müller C, Uhl W (2006). "Neosphincter surgery for fecal incontinence: a critical and unbiased review of the relevant literature". Surg. Today. 36 (4): 295–303. doi:10.1007/s00595-005-3159-4. PMID 16554983.