Skip to main content

Advertisement

Log in

Neosphincter Surgery for Fecal Incontinence: A Critical and Unbiased Review of the Relevant Literature

  • Review Article
  • Published:
Surgery Today Aims and scope Submit manuscript

Abstract

Up until about 15 years ago the only realistic option for end-stage fecal incontinence was the creation of a permanent stoma. There have since been several developments. Dynamic graciloplasty (DGP) and artificial bowel sphincter (ABS) are well-established surgical techniques, which offer the patient a chance for continence restoration and improved quality of life; however, they are unfortunately associated with high morbidity and low success rates. Several trials have been done in an attempt to clarify the advantages and disadvantages of these methods and define their place in the second-line treatment of severe, refractory fecal incontinence. This review presents a critical and unbiased overview of the current status of neosphincter surgery according to the available data in the world literature.

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

Access this article

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

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. KL Pickrell TR Broadbent FW Masters JT Metzger (1952) ArticleTitleConstruction of a rectal sphincter and restoration of anal continence by transplanting the gracilis muscle Ann Surg 135 853–62 Occurrence Handle1:STN:280:Cy2D2MvmsFQ%3D Occurrence Handle14924540

    CAS  PubMed  Google Scholar 

  2. CG Baeten F Spaans A Fluks (1988) ArticleTitleAn implanted neuromuscular stimulator for fecal continence following previously implanted gracilis muscle. Report of a case Dis Colon Rectum 31 134–7 Occurrence Handle1:STN:280:BieC3M%2FovFU%3D Occurrence Handle3338345

    CAS  PubMed  Google Scholar 

  3. CG Baeten J Konsten F Spaans R Visser AM Habets IM Bourgeois et al. (1991) ArticleTitleDynamic graciloplasty for the treatment of faecal incontinence Lancet 338 1163–5 Occurrence Handle10.1016/0140-6736(91)92030-6 Occurrence Handle1:STN:280:By2D2cjoslE%3D Occurrence Handle1682590

    Article  CAS  PubMed  Google Scholar 

  4. NS Williams J Patel BD George RI Hallan ES Watkins (1991) ArticleTitleDevelopment of an electrically stimulated neoanal sphincter Lancet 338 IssueID8776 1166–9 Occurrence Handle10.1016/0140-6736(91)92031-V Occurrence Handle1:STN:280:By2D2cjoslI%3D Occurrence Handle1682591

    Article  CAS  PubMed  Google Scholar 

  5. J Christiansen M Lorentzen (1987) ArticleTitleImplantation of artificial sphincter for anal incontinence Lancet 2 IssueID8553 244–5 Occurrence Handle1:STN:280:BiiB1crot1w%3D Occurrence Handle2886717

    CAS  PubMed  Google Scholar 

  6. WD Wong LL Jensen DC Bartolo DA Rothenberger (1996) ArticleTitleArtificial anal sphincter Dis Colon Rectum 39 1345–51 Occurrence Handle10.1007/BF02054522 Occurrence Handle1:STN:280:ByiC38vkvVw%3D Occurrence Handle8969658

    Article  CAS  PubMed  Google Scholar 

  7. CGMI Baeten O Uludag (2002) ArticleTitleSecond-line treatment for faecal incontinence Scand J Gastroenterol 37 IssueIDSuppl 236 72–5

    Google Scholar 

  8. F Michot B Costaglioli AM Leroi P Denis (2003) ArticleTitleArtificial anal sphincter in severe fecal incontinence Ann Surg 237 52–6 Occurrence Handle12496530

    PubMed  Google Scholar 

  9. AE Chapman B Geerdes P Hewett J Young T Eyers G Kiroff et al. (2002) ArticleTitleSystematic review of dynamic graciloplasty in the treatment of faecal incontinence Br J Surg 89 138–53 Occurrence Handle1:STN:280:DC%2BD387isV2juw%3D%3D Occurrence Handle11856125

    CAS  PubMed  Google Scholar 

  10. MSAC. Placement of artificial bowel sphincters in the management of faecal incontinence (assessment report). Canberra: Medical Services Advisory Committee; 2003. http://www.msac.gov.au/

  11. CGMI Baeten BP Geerdes EMM Adang E Heineman J Konsten GL Engel et al. (1995) ArticleTitleAnal dynamic graciloplasty in the treatment of intractable fecal incontinence N Engl J Med 332 1600–5 Occurrence Handle10.1056/NEJM199506153322403 Occurrence Handle1:STN:280:ByqB2s3msVY%3D Occurrence Handle7753138

    Article  CAS  PubMed  Google Scholar 

  12. F Penninckx (2004) ArticleTitleBelgian experience with dynamic graciloplasty for faecal incontinence Br J Surg 91 872–8 Occurrence Handle10.1002/bjs.4568 Occurrence Handle1:STN:280:DC%2BD2czitlyhuw%3D%3D Occurrence Handle15227694

    Article  CAS  PubMed  Google Scholar 

  13. PA Lehur P Glemain S Bruley des Varannes JM Buzelin J Leborgne (1998) ArticleTitleOutcome of patients with an implanted artificial anal sphincter for severe faecal incontinence Int J Colorect Dis 13 88–92 Occurrence Handle10.1007/s003840050141 Occurrence Handle1:STN:280:DyaK1czgt1emsg%3D%3D

    Article  CAS  Google Scholar 

  14. WD Wong SM Congliosi MP Spencer ML Corman P Tan FG Opelka et al. (2002) ArticleTitleThe safety and efficacy of the artificial bowel sphincter for fecal incontinence: results from a multicenter cohort study Dis Colon Rectum 45 1139–53 Occurrence Handle12352228

    PubMed  Google Scholar 

  15. PE O'Brien JB Dixon S Skinner C Laurie A Khera D Fonda (2004) ArticleTitleA prospective, randomized, controlled clinical trial of placement of the artificial bowel sphincter (Acticon neosphincter) for the control of fecal incontinence Dis Colon Rectum 47 1852–60 Occurrence Handle15622577

    PubMed  Google Scholar 

  16. SC Parker MP Spencer RD Madoff LL Jensen WD Wong DA Rothenberger (2003) ArticleTitleArtificial bowel sphincter: long-term experience at a single institution Dis Colon Rectum 46 722–9 Occurrence Handle10.1007/s10350-004-6647-5 Occurrence Handle12794572

    Article  PubMed  Google Scholar 

  17. Hoebarth G, Pfeifer J. The artificial bowel sphincter implant technique. The Internet Journal of Surgery 2002; Volume 3, Number 2. http://www.ispub.com/

  18. PE O'Brien S Skinner (2000) ArticleTitleRestoring control: The Acticon Neosphincter® artificial bowel sphincter in the treatment of anal incontinence Dis Colon Rectum 43 1213–6 Occurrence Handle10.1007/BF02237423 Occurrence Handle11005485

    Article  PubMed  Google Scholar 

  19. SM Koch O Uludag M Rongen CG Baeten W van Gemert (2004) ArticleTitleDynamic graciloplasty in patients born with an anorectal malformation Dis Colon Rectum 47 1711–9 Occurrence Handle10.1007/s10350-004-0683-z Occurrence Handle15540304

    Article  PubMed  Google Scholar 

  20. GM Da Silva JMN Jorge B Belin JJ Nogueras EG Weiss AM Vernava SuffixIII et al. (2004) ArticleTitleNew surgical options for fecal incontinence in patients with imperforate anus Dis Colon Rectum 47 204–9 Occurrence Handle10.1007/s10350-003-0039-0 Occurrence Handle15043291

    Article  PubMed  Google Scholar 

  21. MJ Thornton ML Kennedy DZ Lubowski DW King (2004) ArticleTitleLong-term follow-up of dynamic graciloplasty for faecal incontinence Colorect Dis 6 470–6 Occurrence Handle10.1111/j.1463-1318.2004.00714.x Occurrence Handle1:STN:280:DC%2BD2crltVKgsw%3D%3D

    Article  CAS  Google Scholar 

  22. V Violi AS Boselli M De Bernardinis R Costi G Nervi A Bertele et al. (2004) ArticleTitleSurgical results and functional outcome after total anorectal reconstruction by double graciloplasty supported by external-source electrostimulation and/or implantable pulse generators: an 8-year experience Int J Colorect Dis 19 219–27 Occurrence Handle10.1007/s00384-003-0528-6

    Article  Google Scholar 

  23. M-JGM Rongen O Uludag K El Naggar BP Geerdes J Konsten CGMI Baeten (2003) ArticleTitleLong-term follow-up of dynamic graciloplasty for fecal incontinence Dis Colon Rectum 46 716–21 Occurrence Handle10.1007/s10350-004-6645-7 Occurrence Handle12794571

    Article  PubMed  Google Scholar 

  24. H Ortiz P Armendariz M DeMiguel A Solana R Alos JV Roig (2003) ArticleTitleProspective study of artificial anal sphincter and dynamic graciloplasty for severe anal incontinence Int J Colorect Dis 18 349–54 Occurrence Handle1:STN:280:DC%2BD3s3kvF2hsw%3D%3D

    CAS  Google Scholar 

  25. SD Wexner C Baeten R Bailey A Bakka B Belin P Belliveau et al. (2002) ArticleTitleLong-term efficacy of dynamic graciloplasty for fecal incontinence Dis Colon Rectum 45 809–18 Occurrence Handle12072635

    PubMed  Google Scholar 

  26. J Konsten MJ Rongen OA Ogunbiyi A Darakhshan CG Baeten NS Williams (2001) ArticleTitleComparison of epineural or intramuscular nerve electrodes for stimulated graciloplasty Dis Colon Rectum 44 581–6 Occurrence Handle10.1007/BF02234333 Occurrence Handle1:STN:280:DC%2BD3M3jvVGnsQ%3D%3D Occurrence Handle11330587

    Article  CAS  PubMed  Google Scholar 

  27. E Rullier F Zerbib C Laurent M Caudry J Saric (2000) ArticleTitleMorbidity and functional outcome after double dynamic graciloplasty for anorectal reconstruction Br J Surg 87 909–13 Occurrence Handle10.1046/j.1365-2168.2000.01447.x Occurrence Handle1:STN:280:DC%2BD3cvgtFymtQ%3D%3D Occurrence Handle10931027

    Article  CAS  PubMed  Google Scholar 

  28. CG Baeten HR Bailey A Bakka P Belliveau E Berg WD Buie et al. (2000) ArticleTitleSafety and efficacy of dynamic graciloplasty for fecal incontinence: report of a prospective, multicenter trial. Dynamic Graciloplasty Therapy Study Group Dis Colon Rectum 43 743–51 Occurrence Handle10.1007/BF02238008 Occurrence Handle1:STN:280:DC%2BD3czhsFKjtg%3D%3D Occurrence Handle10859072

    Article  CAS  PubMed  Google Scholar 

  29. BJ Mander SD Wexner NS Williams DC Bartolo DZ Lubowski T Oresland et al. (1999) ArticleTitlePreliminary results of a multicentre trial of the electrically stimulated gracilis neoanal sphincter Br J Surg 86 1543–8 Occurrence Handle10.1046/j.1365-2168.1999.01285.x Occurrence Handle1:STN:280:DC%2BD3c%2Fmt1ChtA%3D%3D Occurrence Handle10594503

    Article  CAS  PubMed  Google Scholar 

  30. P Rouanet P Senesse D Bouamrirene E Toureille M Veyrac C Astre et al. (1999) ArticleTitleAnal sphincter reconstruction by dynamic graciloplasty after abdominoperineal resection for cancer Dis Colon Rectum 42 451–6 Occurrence Handle10.1007/BF02234165 Occurrence Handle1:STN:280:DyaK1M3ivFyrsA%3D%3D Occurrence Handle10215043

    Article  CAS  PubMed  Google Scholar 

  31. V Violi L Roncoroni AS Boselli C De Cesare M Livrini A Peracchia (1999) ArticleTitleTotal anorectal reconstruction by double graciloplasty: experience with delayed, selective use of implantable pulse generators Int J Colorect Dis 14 164–71 Occurrence Handle10.1007/s003840050204 Occurrence Handle1:STN:280:DyaK1MzptFyhtw%3D%3D

    Article  CAS  Google Scholar 

  32. E Cavina M Seccia P Banti G Zocco (1998) ArticleTitleAnorectal reconstruction after abdominoperineal resection. Experience with double-wrap graciloplasty supported by low-frequency electrostimulation Dis Colon Rectum 41 1010–6 Occurrence Handle10.1007/BF02237392 Occurrence Handle1:STN:280:DyaK1czotVyqsg%3D%3D Occurrence Handle9715158

    Article  CAS  PubMed  Google Scholar 

  33. HR Rosen G Novi G Zoech W Feil C Urbarz R Schliessel (1998) ArticleTitleRestoration of anal sphincter function by single-stage dynamic graciloplasty with a modified (split sling) technique Am J Surg 175 187–93 Occurrence Handle10.1016/S0002-9610(97)00289-4 Occurrence Handle1:STN:280:DyaK1c3hvFSntg%3D%3D Occurrence Handle9560117

    Article  CAS  PubMed  Google Scholar 

  34. BP Geerdes FA Zoetmulder E Heineman EJ Vos MG Rongen CG Baeten (1997) ArticleTitleTotal anorectal reconstruction with a double dynamic graciloplasty after abdominoperineal reconstruction for low rectal cancer Dis Colon Rectum 40 698–705 Occurrence Handle1:STN:280:ByiA3sjnslU%3D Occurrence Handle9194465

    CAS  PubMed  Google Scholar 

  35. DF Altomare M Rinaldi OC Pannarale V Memeo (1997) ArticleTitleElectrostimulated gracilis neosphincter for faecal incontinence and in total anorectal reconstruction: still and experimental procedure? Int J Colorect Dis 12 308–12 Occurrence Handle10.1007/s003840050112 Occurrence Handle1:STN:280:DyaK1c%2FmsFCisg%3D%3D

    Article  CAS  Google Scholar 

  36. BJ Mander JF Abercrombie BD George NS Williams (1996) ArticleTitleThe electrically stimulated gracilis neosphincter incorporated as part of total anorectal reconstruction after abdominoperineal excision of the rectum Ann Surg 224 702–11 Occurrence Handle10.1097/00000658-199612000-00006 Occurrence Handle1:STN:280:ByiC383pslI%3D Occurrence Handle8968225

    Article  CAS  PubMed  Google Scholar 

  37. DF Altomare GA Binda G Dodi F La Torre G Romano M Rinaldi et al. (2004) ArticleTitleDisappointing long-term results of the artificial anal sphincter for faecal incontinence Br J Surg 91 1352–3 Occurrence Handle10.1002/bjs.4600 Occurrence Handle1:STN:280:DC%2BD2crhsVSjsg%3D%3D Occurrence Handle15376181

    Article  CAS  PubMed  Google Scholar 

  38. E Casal A San Ildefonso R Carracedo C Facal JA Sanchez (2004) ArticleTitleArtificial bowel sphincter in severe anal incontinence Colorect Dis 6 180–4 Occurrence Handle10.1111/j.1463-1318.2004.00609.x Occurrence Handle1:STN:280:DC%2BD2c3ht1OgsA%3D%3D

    Article  CAS  Google Scholar 

  39. G Romano F La Torre G Cutini F Bianco P Esposito A Montori (2003) ArticleTitleTotal anorectal reconstruction with the artificial bowel sphincter: report of eight cases. A quality-of-life assessment Dis Colon Rectum 46 730–4 Occurrence Handle10.1007/s10350-004-6649-3 Occurrence Handle12794573

    Article  PubMed  Google Scholar 

  40. JM Devesa A Rey PL Hervas KS Halawa I Larranaga L Svidler et al. (2002) ArticleTitleArtificial anal sphincter: complications and functional results of a large personal series Dis Colon Rectum 45 1154–63 Occurrence Handle10.1007/s10350-004-6382-y Occurrence Handle12352229

    Article  PubMed  Google Scholar 

  41. PA Lehur F Zerbib M Neunlist P Glemain S Bruley des Varannes (2002) ArticleTitleComparison of quality of life and anorectal function after artificial sphincter implantation Dis Colon Rectum 45 508–13 Occurrence Handle10.1007/s10350-004-6230-0 Occurrence Handle12006933

    Article  PubMed  Google Scholar 

  42. H Ortiz P Armendariz M DeMiguel MD Ruiz R Alos JV Roig (2002) ArticleTitleComplications and functional outcome following artificial anal sphincter implantation Br J Surg 89 877–81 Occurrence Handle1:STN:280:DC%2BD38zjvFCmug%3D%3D Occurrence Handle12081737

    CAS  PubMed  Google Scholar 

  43. PA Lehur JV Roig M Duinslaeger (2000) ArticleTitleArtificial anal sphincter: prospective clinical and manometric evaluation Dis Colon Rectum 43 1100–6 Occurrence Handle10.1007/BF02236557 Occurrence Handle1:STN:280:DC%2BD3cvitVSgtA%3D%3D Occurrence Handle10950008

    Article  CAS  PubMed  Google Scholar 

  44. G Dodi E Melega A Masin A Infantino F Cavallai M Lise (2000) ArticleTitleArtificial bowel sphincter (ABS) for severe faecal incontinence: a clinical and manometric study Colorect Dis 2 207–11 Occurrence Handle10.1046/j.1463-1318.2000.00157.x

    Article  Google Scholar 

  45. J Christiansen OO Rasmussen K Lindorff-Larsen (1999) ArticleTitleLong-term results of artificial anal sphincter implantation for severe anal incontinence Ann Surg 230 45–8 Occurrence Handle10.1097/00000658-199907000-00007 Occurrence Handle1:STN:280:DyaK1MzisFKhsA%3D%3D Occurrence Handle10400035

    Article  CAS  PubMed  Google Scholar 

  46. CJ Vaizey MA Kamm DM Gold CI Bartram S Halligan RJ Nicholls (1998) ArticleTitleClinical, physiological, and radiological study of a new purpose-designed artificial bowel sphincter Lancet 351 105–9

    Google Scholar 

  47. A Gelet P Meunier RL Platet AF AbdelRahim S Friaa JG Lopez et al. (1997) ArticleTitleTreatment of dual urinary and fecal incontinence by implantation of two AMS 800 artificial sphincters. Case report Eur Urol 31 115–7 Occurrence Handle1:STN:280:ByiC1cvnslM%3D Occurrence Handle9032547

    CAS  PubMed  Google Scholar 

  48. KF Schulz I Chalmers RJ Hayes D Altman (1995) ArticleTitleEmpirical evidence of bias. Dimensions of methodological quality associated with estimates of treatment effects in controlled trials JAMA 273 408–12 Occurrence Handle10.1001/jama.273.5.408 Occurrence Handle1:STN:280:ByqC38zntFI%3D Occurrence Handle7823387

    Article  CAS  PubMed  Google Scholar 

  49. IG Finlay W Richardson CA Hajivassiliou (2004) ArticleTitleOutcome after implantation of a novel prosthetic anal sphincter in humans Br J Surg 91 1485–92 Occurrence Handle1:STN:280:DC%2BD2crksVOqsA%3D%3D Occurrence Handle15382094

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

About this article

Cite this article

Belyaev, O., Müller, C. & Uhl, W. Neosphincter Surgery for Fecal Incontinence: A Critical and Unbiased Review of the Relevant Literature. Surg Today 36, 295–303 (2006). https://doi.org/10.1007/s00595-005-3159-4

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00595-005-3159-4

Key words

Navigation