Artificial bowel sphincter in severe anal incontinence

Abstract

Our findings indicate that the ACTICON artificial anal sphincter is well tolerated and can be an effective alternative in the treatment of severe anal incontinence. Although complete continence is only achieved in a low percentage of cases, for the rest of the patients the ACTICON neosphincter reduces the symptoms considerably.

Challenges faced in the clinical application of artificial anal sphincters

“…The clinical application of AAS has been studied by many experts, and this paper summarizes and analyzes the most important 24 studies from 1996 to 2010 (Lehur et al, 1996;2000;Wong et al, 1996;Vaizey et al, 1998;Christiansen et al, 1999;Dodi et al, 2000;Malouf et al, 2000;O'Brien and Skinner, 2000;Altomare et al, 2001;2004;Devesa et al, 2002;Ortiz et al, 2002;Michot et al, 2003;Parker et al, 2003;Romano et al, 2003;Casal et al, 2004;O'Brien et al, 2004;Ruiz Carmona et al, 2009;Gallas et al, 2009;Meurette et al, 2009;Chittawatanarat et al, 2010). These studies focused chiefly on results from the clinical application of the AMS series sphincter (the unmodified AMS800, the modified version of the AMS800, and the final version, the Acticon Neosphincter) from the point of view of safety and efficacy.…”

“…Seventeen papers (Lehur et al, 1996;2000;Wong et al, 1996;Vaizey et al, 1998;Christiansen et al, 1999;Dodi et al, 2000;Malouf et al, 2000;O'Brien and Skinner, 2000;Altomare et al, 2001;Devesa et al, 2002;Ortiz et al, 2002;Parker et al, 2003;Casal et al, 2004;Ruiz Carmona et al, 2009;Chittawatanarat et al, 2010) reported the infection rate, which varied between 4% (Lehur et al, 2000) and 50% (Chittawatanarat et al, 2010). In three papers of Lehur et al (1996;2000), the frequencies of infection were 15%, 8%, and 4%, respectively.…”

“…Nine papers (Lehur et al, 1996;Wong et al, 1996;Christiansen et al, 1999;Devesa et al, 2002;Ortiz et al, 2002;Michot et al, 2003;Altomare et al, 2004;Casal et al, 2004;Ruiz Carmona et al, 2009) mentioned mechanical complications, the frequency of which varied between 2% (Devesa et al, 2002) and 29% (Ruiz Carmona et al, 2009). The mechanical failure rate reported by Lehur et al (1996) was 23%.…”

“…Fifteen papers (Wong et al, 1996;Lehur et al, 1998;2000;Vaizey et al, 1998;Christiansen et al, 1999;Dodi et al, 2000;O'Brien and Skinner, 2000;Altomare et al, 2001;Parker et al, 2003;Romano et al, 2003;Casal et al, 2004;O'Brien et al, 2004;Chittawatanarat et al, 2010) used a fecal incontinence score (FIS) to assess the severity of incontinence of patients. Four scoring systems were adopted: Williams Scale (WS), AMS Fecal Incontinence Score (AMSFIS), Cleveland Continence Score (CCS), and Wexner Continence Grading Score (WCGS) (Jorge and Wexner, 1993;Vaizey et al, 1999;Mundy et al, 2004), as shown in Table 1.…”

“…Anorectal pressure is generally used to assess sphincter function, and the resting anal pressure reflects the function of the internal sphincter. Seventeen papers (Lehur et al, 1996;2000;Wong et al, 1996;Vaizey et al, 1998;Dodi et al, 2000;Altomare et al, 2001;2004;Devesa et al, 2002;Ortiz et al, 2002;Michot et al, 2003;Romano et al, 2003;Casal et al, 2004;Ruiz Carmona et al, 2009;Chittawatanarat et al, 2010) measured the anal pressure. The lowest mean resting anal pressure before operation was 16 mmHg (1 mmHg=0.133 kPa), and the corresponding postoperative resting pressure was 68 mmHg (Wong et al, 1996).…”