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Clin Colon Rectal Surg 2003; 16(3): 173-180
DOI: 10.1055/s-2003-42900
Copyright © 2002 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel.: +1(212) 584-4662

New Options for the Treatment of Fecal Incontinence

David A. Margolin
  • Department of Colon and Rectal Surgery, Ochsner Clinic Foundation, New Orleans, Louisiana
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Publication History

Publication Date:
10 October 2003 (online)

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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
    PubMedGoogle Scholar
  • 2 Johanson J F, Lafferty J. Epidemiology of fecal incontinence: the silent affliction.  Am J Gastroenterology . 1996;  91 33-36
    PubMedGoogle Scholar
  • 3 Nelson R, Norton N, Cautley E, Furner S. Community-based prevalence of anal incontinence.  JAMA . 1995;  274 559-561
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    Google Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 9 Shafik A. Perianal injection of autologous fat for the treatment of sphincteric incontinence.  Dis Colon Rectum . 1995;  38 583-587
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 12 Shaik A. Polytetrafluorethylene injection for the treatment of partial faecal incontinence.  Int Surg . 1993;  78 159-161
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 18 Dalby S W. Opening the cecum for intestinal obstruction (Report of the Medical Society of London) Br Med J .  1894;  17 12
    PubMedGoogle Scholar
  • 19 Keetley C B. Appendicostomy.  Br Med J . 1905;  7 863-865
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 21 Williams N S, Hughes S F, Stuchfield B. Continent colonic conduit for rectal evacuation in severe constipation.  Lancet . 1994;  343 1321-1324
    CrossrefPubMedGoogle Scholar
  • 22 Chetwood C H. Plastic operation for restoration of the sphincter ani with report of a case.  Med Rec . 1902;  61 529
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 25 Devesa J M, Madrid J M, Gallego B R. et al . Bilateral gluteoplasty for fecal incontinence.  Dis Colon Rectum . 1997;  40 883-888
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 27 Salmons S, Henriksson J. The adapive response of skeletal muscle to increased use.  Muscle Nerve . 1981;  4 94-105
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 30 Matzel K E, Madoff R D, LaFontaine L J. et al . Complications of dynamic graciloplasty.  Dis Colon Rectum . 2001;  44 1427-1435
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
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