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Is magnetic anal sphincter augmentation still an option in fecal incontinence treatment: a systematic review and meta-analysis

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Abstract

Purpose

Magnetic anal sphincter (MAS) augmentation is a novel surgical option for the treatment of fecal incontinence. Current clinical evidence is conflicting. The purpose of this meta-analysis was to report the safety profile, potential benefits, and the functional efficacy of this device.

Methods

The study followed the PRISMA guidelines. Literature databases (Medline, Scopus, Web of Science, CENTRAL) were screened for eligible articles. The primary endpoint was the pooled effect of MAS in the Cleveland Clinic Incontinence Score (CCIS) score. Quality evaluation was based on the ROBINS-I and Risk of Bias 2 tool.

Results

Overall, 8 studies with 205 patients were included. MAS resulted in a significant reduction of CCIS values (p = 0.019), and improvement only in the embarrassment domain of FIQoL scores (p = 0.034). The overall morbidity rate was 61.8%. Postoperative adverse events included MAS explantation in 12%, infection in 5.1%, pain in 10% and obstructed defecation in 5.8% of patients.

Conclusion

The application of MAS in patients with fecal incontinence results in the improvement of some clinical parameters with a notable morbidity rate. Due to several study limitations, further, high-quality RCTs are required to delineate the efficacy and safety of MAS.

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Data availability

Data available upon request from the authors.

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Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Department of Surgery, “Achillopouleion” General Hospital, Volos, Greece

    Stavros Chrysovalantis Liapis, Konstantinos Perivoliotis, Amalia Ioanna Moula, Kyriakos Psarianos, Alexios Stavrou & Dimitrios Lytras

  2. Department of Surgery, University Hospital of Larissa, Larissa, Greece

    Konstantinos Perivoliotis & Ioannis Baloyiannis

  3. Department of Surgery, “Asclepeion Voula’s” General Hospital, Voula, Greece

    Prokopis Christodoulou

Authors
  1. Stavros Chrysovalantis Liapis
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  2. Konstantinos Perivoliotis
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  3. Amalia Ioanna Moula
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  4. Prokopis Christodoulou
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  5. Kyriakos Psarianos
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  6. Alexios Stavrou
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  7. Ioannis Baloyiannis
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  8. Dimitrios Lytras
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Contributions

Conception and design of the study: Liapis, Perivoliotis.

Acquisition of data: Liapis, Moula.

Drafting the article: Liapis, Perivoliotis, Moula.

Critical revision: Baloyiannis, Lytras, Psarianos, Stavrou.

Final approval: Baloyiannis, Lytras.

Corresponding author

Correspondence to Stavros Chrysovalantis Liapis.

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Supplementary file1 (PDF 1079 KB)

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Appendix

Appendix

Figures 1, 2 and 3

Fig. 1
figure 1

Study Flow Diagram

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Fig. 2
figure 2

Cleveland Clinic Incontinence Score (Wexner score). Forest plot

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Fig. 3
figure 3

Primary outcome funnel plot

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Tables 1 and 2

Table 1 Included studies, demographics, and preoperative data. *BMI = Body Mass Index, CCIS = Cleveland Clinic In-continence Score, ODS = Obstructive Defecation Syndrome
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Table 2 Meta-analysis of primary and secondary endpoints. MD = mean difference, RP = raw proportion, L 95%CI = lower 95% confidence interval, U 95%CI = upper 95% confidence interval, CCIS = Cleveland Clinic Incontinence Score, LOS = length of stay in days
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Liapis, S.C., Perivoliotis, K., Moula, A.I. et al. Is magnetic anal sphincter augmentation still an option in fecal incontinence treatment: a systematic review and meta-analysis. Langenbecks Arch Surg 409, 98 (2024). https://doi.org/10.1007/s00423-024-03288-x

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