A team from Italy conducted a multicenter retrospective analysis of the outcome of artificial anal sphincter implantation for severe fecal incontinence.
The new prosthetic device, the ActiconTM artificial anal sphincter, has recently been introduced for treating this problem.
The researchers enrolled 28 patients to undergo the operation for severe fecal incontinence, in 4 Italian university hospitals.
Subjects were reviewed after a median follow-up of 19 months.
Early infections occurred in 4 patients, requiring removal of the device in 3. Dehiscence of the perineal wound occurred in 9 patients.
After activation of the device, the cuff had to be removed in a further 4 patients (for rectal erosion in 2, anal pain in 1, and late infection in 1).
The cuff was accidentally broken in 1 patient. A new anal cuff was repositioned successfully in 2 patients.
Overall, 5 patients had complete removal of the device and 2 removal of the cuff only.
| Acticon improved continence in 75% of patients.
| British Journal of Surgery |
The 21 patients available for long-term evaluation had a major improvement in fecal continence.
Median resting anal pressure increased from 27 mm Hg before surgery, to 32 mm Hg after operation.
Preoperative squeeze pressure was 42 mm Hg, while maximum postoperative anal pressure with the activated device was 67 mm Hg.
The median American Medical System incontinence score decreased significantly from 98·5 to 5·5. Similar figures were observed using the Continence Grading Scale (from 14·9 to 2·6).
Some 12 patients developed symptoms of obstructed defecation, while 2 patients complained of anal pain.
Dr D. F. Altomare, of the University of Bari, said on behalf of the group, "Improved continence was achieved after neosphincter implantation in three-quarters of the patients."
"Early infection and rectal erosion, together with difficulty in evacuating, are still major concerns with this technique," it was concluded.