Skip to main content

Advertisement

SpringerLink
Log in

Prospective study of artificial anal sphincter and dynamic graciloplasty for severe anal incontinence

  • Original Article
  • Published:
International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Background and aims

Dynamic graciloplasty and artificial anal sphincter are two options for refractory incontinence, the efficacy of which was compared in a prospective study.

Patients and methods

Between November 1966 and June 1998, 16 patients were operated on (artificial anal sphincter 8, dynamic graciloplasty 8). Four consecutive operations with each technique were performed by two colorectal surgeons (one initiated the study with the neosphincter and the other with dynamic graciloplasty). Two independent observers assessed postoperative results at 4-month intervals. Patients were followed up to January 2001, with a median (interquartile range) of 44 (13) months and 39 (15) months for the nesophincter and the dynamic graciloplasty, respectively.

Results

Fourteen patients had complications. In the immediate postoperative period; there were eight cases of wound healing-related problems (four in the graciloplasty group). Perineal infection occurred in one patient in the graciloplasty group. At follow-up there were 11 complications (6 in the neosphincter group). Four patients undergoing neosphincter implantation had erosion or pain at the cuff site and had the implant removed (a new device was reimplanted in one). Four patients undergoing dynamic graciloplasty had the stimulator removed. Postoperatively the neosphincter was associated with a significantly lower score on the continence grading scale of the Cleveland Clinic Florida than graciloplasty.

Conclusion

The artificial anal sphincter is a more convenient technique than dynamic graciloplasty for institutions treating small number of patients. However, technical failures and complications during follow-up that require reoperation are very high in both types of treatments.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1.

Similar content being viewed by others

References

  1. Baeten GCMI, Bailey HR, Bakka A, Belliveau P, Berg E, Buie WD, et al (2000) Safety and efficacy of dynamic graciloplasty for fecal incontinence. Report of a prospective multicenter study. Dis Colon Rectum 43:743–751

    CAS  PubMed  Google Scholar 

  2. Lehur PA, Roig JV, Duinslaeger M (2000) Artificial anal sphincter. Prospective clinical and manometric evaluation. Dis Colon Rectum 43:1100–1106

    CAS  PubMed  Google Scholar 

  3. Madoff RD, Baeten CGMI, Christiansen J, Rosen HR, Williams NS, Heine JA, et al (2000) Standards for anal sphincter replacement. Dis Colon Rectum 43:135–141

    PubMed  Google Scholar 

  4. Jorge JMN, Wexner SD (1993) Etiology and management of fecal incontinence. Dis Colon Rectum 36:77–97

    PubMed  Google Scholar 

  5. Baeten CGMI, Konsten J, Spaans F, Visser R, Habets AMM, Bourgeois IM, et al (1991) Dynamic graciloplasty for treatment of faecal incontinence. Lancet 338:1163–1165

    PubMed  Google Scholar 

  6. Lehur PA, Michot F, Denis P, Grise P, Leborgne J, Teniere P, et al (1996) Results of artificial sphincter in severe anal incontinence. Report of 14 consecutive implantations. Dis Colon Rectum 39:1352–1355

    CAS  PubMed  Google Scholar 

  7. Malouf AJ, Vaizey CJ, Kamm MA, Nicholls RJ (2000) Reassessing artificial bowel sphincters. Lancet 355;2210–2220

    Google Scholar 

  8. O'Brien PE, Skinner S (2000) Restoring control: the Acticon Neosphincter artificial bowel sphincter in the treatment of anal incontinence. Dis Colon Rectum 43:1213–1216

    CAS  PubMed  Google Scholar 

  9. Vaizey CJ, Kamm MA, Gold DM, Bartram CI, Halligan S, Nicholls RJ (1998) Clinical, physiological, and radiological study of a new purpose-designed artificial bowel sphincter. Lancet 352:105–109

    CAS  PubMed  Google Scholar 

  10. Wong WD, Jensen LL, Bartolo DCC, Rothenberger DA (1966) Artificial anal sphincter. Dis Colon Rectum 12:1345–1351

    Google Scholar 

  11. Dodi G, Melega E, Masin A, Infantino A, Cavallari F, Lise M (2000) Artificial bowel sphincter (ABS) for severe faecal incontinence: a clinical and manometric study. Int J Colorectal Dis 2:207–211

    Article  Google Scholar 

  12. Madoff RD, Rosen HR, Baeten CG, LaFontaine LJ, Cavina E, Devesa M, et al (1999) Safety and efficacy of dynamic muscle plasty for anal incontinence: lessons from a prospective, multicenter trial. Gastroenterology 116:549–556

    CAS  PubMed  Google Scholar 

  13. Mander BJ, Wexner SD, Williams NS, Bartolo DC, Lubowski DZ, Oresland T, et al (1999) Preliminary results of a multicentre trial of the electrically stimulated gracilis neoanal sphincter. Br J Surg 86:1543–1548

    Article  CAS  PubMed  Google Scholar 

  14. Mavrantonis C, Wexner SD (2000) Stimulated graciloplasty for treatment of intractable fecal continence. Critical influence of the method of stimulation. Dis Colon Rectum 42:497–504

    Google Scholar 

  15. Savoye G, Leroy AM, Denis P, Michot F (2000) Manometric assessment of an artificial bowel sphincter. Br J Surg 87:586–589

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

We thank Marta Pulido, M.D., for editing the manuscript and editorial assistance.

Author information

Authors and Affiliations

  1. Unit of Coloproctology, Department of Surgery, Hospital Virgen del Camino, Pamplona, Universidad Pública de Navarra, C/Irunlarrea s/n, 31008, Pamplona, Navarra, Spain

    H. Ortiz, P. Armendariz & M. DeMiguel

  2. Unit of Coloproctology, Department of Surgery, Hospital de Sagunto, Sagunto, Valencia, Spain

    A. Solana, R. Alós & J. V. Roig

Authors
  1. H. Ortiz
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. P. Armendariz
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. M. DeMiguel
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. A. Solana
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. R. Alós
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. J. V. Roig
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to H. Ortiz.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Ortiz, H., Armendariz, P., DeMiguel, M. et al. Prospective study of artificial anal sphincter and dynamic graciloplasty for severe anal incontinence. Int J Colorectal Dis 18, 349–354 (2003). https://doi.org/10.1007/s00384-002-0472-x

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00384-002-0472-x

Keywords

Search

Navigation