The Artificial Bowel Sphincter in the Treatment of Fecal Incontinence, Long-term Complications

Aart A. van der Wilt*, Stephanie O. Breukink, Rosel Sturkenboom, Laurents P. Stassen, Cornelius G. Baeten, Jarno Melenhorst

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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Abstract

BACKGROUND: Fecal incontinence is a common and debilitating condition, of which the prevalence increases with age. Several medical and minimally invasive treatment modalities are available. However, for patients with greater sphincter defects, these treatments are often not sufficient. For these patients, the artificial bowel sphincter could be an alternative to colostomy. The artificial bowel sphincter has proven to be effective in the short term. Less is known whether the benefits sustain over time.

OBJECTIVE: The aim of this study was to assess the long-term outcome of the artificial bowel sphincter in patients with refractory fecal incontinence.

DESIGN: A retrospective record review was conducted in conjunction with questionnaires.

SETTING: This study was conducted in a tertiary hospital setting.

MAIN OUTCOME MEASURES: The primary end point was any complication. The secondary end point was fecal loss.

PATIENTS: The patients included were adults experiencing severe fecal incontinence treated with artificial bowel sphincter, operated on between 1997 and 2014.

RESULTS: Sixty-three patients were included in this study. After a median follow-up of 57 months (range, 1-198), the device had been explanted in 31 patients (49.2%; 95% CI, 36.5-62.0). In total, 101 reoperations were conducted, ranging from 1 to 6 reoperations per patient. The main reasons for revision were device failure and infection. At 5 years follow-up, 80% of the cohort had experienced a complication requiring surgery. Twenty-two (35%) patients had restored continence.

LIMITATIONS: This study was limited by its retrospective design and subjective secondary outcome.

CONCLUSION: Patients with severe end-stage fecal incontinence can benefit from artificial bowel sphincter, but this requires a large number of reoperations, and at least 20% of patients will eventually have a colostomy. Therefore, careful patient selection and the involvement of patients in decision making regarding the potential benefits and limitations of this technique are paramount.

Original languageEnglish
Pages (from-to)1134-1141
Number of pages8
JournalDiseases of the Colon & Rectum
Volume63
Issue number8
DOIs
Publication statusPublished - Aug 2020

Keywords

  • Artificial bowel sphincter
  • Complication
  • Fecal incontinence
  • Follow-up
  • Long-term
  • Reoperation
  • MAGNETIC ANAL-SPHINCTER
  • QUALITY-OF-LIFE
  • IMPLANTATION
  • COLOSTOMY
  • SAFETY
  • CELLS

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