Advertisement

International Journal of Colorectal Disease

, Volume 32, Issue 3, pp 437–440 | Cite as

Ultrasonographic evidence of Gatekeeper™ prosthesis migration in patients treated for faecal incontinence: a case series

  • F de la Portilla
  • ML Reyes-Díaz
  • MV Maestre
  • RM Jiménez-Rodríguez
  • AM García-Cabrera
  • JM Vázquez-Monchul
  • JM Díaz-Pavón
  • FC Padillo-Ruiz
Rapid Communication

Abstract

Background

Faecal incontinence (FI) is both a medical and social problem, with an underestimated incidence. For patients with internal anal sphincter damage, implantation of biomaterial in the anal canal is a recognised treatment option. One such material, Gatekeeper™, has previously shown promising short- and medium-term results without any major complications, including displacement. The main aim of the present study is to assess the degree to which displacement of Gatekeeper prostheses may occur and to determine whether this is associated with patient outcomes.

Methods

Seven patients (six females) with a mean age of 55.6 years [50.5–57.2] and a mean FI duration of 6 ± 2 years were prospectively enrolled in the study. Each subject was anaesthetised and underwent implantation of six prostheses in the intersphincteric region, guided by endoanal 3D ultrasound (3D-EAU). Follow-up was performed at post-interventional months 1, 3, and 12 (median 12 ± 4 months), during which data were obtained from a defaecation diary, Wexner scale assessment, anorectal manometry (ARM), 3D-EAU, and a health status and quality of life questionnaire (FIQL).

Results

At 3-month follow-up, 3D-EAU revealed displacement of 24/42 prostheses in 5/7 patients. Of these, 15 had migrated to the lower portion and 9 to the upper portion of the anal canal and rectum. Despite this migration, treatment was considered successful in 3/7 patients. In one patient, it was necessary to remove a prosthesis due to spontaneous extrusion.

Conclusions

We have shown that displacement of the Gatekeeper™ prosthesis occurs, but is not associated with poorer clinical outcomes.

Keywords

Faecal incontinence Prostheses Migration Endoanal ultrasound Results 

Notes

Compliance with ethical standards

The study protocol was approved by the Ethics Committee of the Virgen del Rocío Hospital, and all patients gave written informed consent to participate.

References

  1. 1.
    Duelund-Jakobsen J, Worsoe J, Lundby L, Christensen P, Krogh K (2016) Management of patients with faecal incontinence. Therap Adv Gastroenterol 9:86–97. doi: 10.1177/1756283X15614516 CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Ditah I, Devaki P, Luma H, Ditah C, Njei B, Jaiyeoba C et al (2014) Prevalence, trends, and risk factors for fecal incontinence in United States adults, 2005–2010. Clin Gastroenterol Hepatol 2:636–643. doi: 10.1016/j.cgh.2013.07.020 CrossRefGoogle Scholar
  3. 3.
    Van Koughnett JA, Wexner SD (2013) Current management of fecal incontinence: choosing amongst treatment options to optimize outcomes. World J Gastroenterol 19:9216–9230. doi: 10.3748/wjg.v19.i48.9216 CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Kenefick NJ, Vaizey CJ, Malouf AJ, Norton CS, Marshall M, Kamm MA (2002) Injectable silicone biomaterial faecal incontinence due to internal anal sphincter dysfunction. Gut 51:225–228CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Al-Ozaibi L, Kazim Y, Hazim W, Al-Mazroui A, Al-Badri F (2014) The Gatekeeper™ for fecal incontinence: another trial and error. Int J Surg Case Rep 5:936–938. doi: 10.1016/j.ijscr.2014.08.002 CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Ratto C, Buntzen S, Aigner F, Altomare DF, Heydari A, Donisi L, Lundby L, Parello A (2016) Multicentre observational study of the Gatekeeper for faecal incontinence. Br J Surg 103:290–299. doi: 10.1002/bjs.10050 CrossRefPubMedGoogle Scholar
  7. 7.
    Ratto C, Parello A, Donisi L, Litta F, De Simone V, Spazzafumo L, Giordano P (2011) Novel bulking agent for faecal incontinence. Br J Surg 98:1644–1652. doi: 10.1002/bjs.7699 CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Shafik A (1993) Polytetrafluoroethylene injection for the treatment of partial fecal incontinence. Int Surg 78:159–161PubMedGoogle Scholar
  9. 9.
    Vaizey CJ, Kamm MA (2005) Injectable bulking agents for treating faecal incontinence. Br J Surg 92:521–527. doi: 10.1002/bjs.4997 CrossRefPubMedGoogle Scholar
  10. 10.
    Rames RA, Aaronson IA (1991) Migration of polytef paste to the lung and brain following intravesical injection for the correction of reflux. Pediatr Surg Int 6:239–240CrossRefGoogle Scholar
  11. 11.
    de la Portilla F, De Marco F, Molero M, Sánchez-Hurtado MA, Pereira S (2015) Calcium alginate as a rectal bulking agent. Experimental pilot study to determine its migratory trend and locoregional reaction. Int J Color Dis 31:1251–1252. doi: 10.1007/s00384-015-2451-z CrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2017

Authors and Affiliations

  • F de la Portilla
    • 1
    • 2
  • ML Reyes-Díaz
    • 1
  • MV Maestre
    • 1
  • RM Jiménez-Rodríguez
    • 1
  • AM García-Cabrera
    • 1
  • JM Vázquez-Monchul
    • 1
  • JM Díaz-Pavón
    • 1
  • FC Padillo-Ruiz
    • 1
  1. 1.Coloproctology Unit. Clinical Management Unit of General and Gastrointestinal Surgery DivisionSeville Biomedical Research Institute (IBIS). University Hospital Virgen del Rocío/CSIC/University of SevilleSevilleSpain
  2. 2.Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD o Ciberehd)Instituto de Salud Carlos IIIMadridSpain

Personalised recommendations