The use of a simple anal sling in the management of anal incontinence

Abstract

Background. Many patients presenting with anal incontinence (AI) are frail, with attendant comorbidities precluding the use of complicated, expensive reconstructive techniques. In these cases, revisiting a simple approach—designed to provide some sort of effective barrier to stool—is worthwhile where the options include a customized peri-anal sling or the use of an anal plug.Methods. Analysis of an unselected cohort of 33 patients (mean age 54 years; range 27–86 years) with AI is presented, these patients having undergone insertion of an elastic band peri-anal sling between December 2004 and December 2009. Pre- and post-operative assessment included the Jorge-Wexner score of incontinence, anorectal manometry and the Rockwood Fecal Incontinence Quality of Life (FIQoL) score.Results. The follow-up period ranged from 50 to 108 months with a mean of 65 months. Early post-operative complications included spontaneous disruption of the sling at the fourth and seventh post-operative day in two patients and local infection in a further two cases. Late complications included skin erosion in two patients, (one occurring 3 years post-operatively) and breakage of the sling in a further seven patients. Explantation was performed in 13 cases, and re-implantation in 10 patients. No differences were noted in resting or squeeze manometry, with significant improvement in the Jorge-Wexner scores in 32 cases and in all of the four Rockwood quality of life scales.Conclusions. An anal sling is an effective and simple surgical option for the management of selected cases presenting with anal incontinence. Longer-term data are awaited comparing this technique with other standard surgical alternatives.

Comparison of Delorme-Thiersch Operation Outcomes in Men and Women With Rectal Prolapse

“…Anal encirclement alone is associated with a high recurrence rate and fecal impaction can occur after surgery because the prolapsed rectum remains in place. Thiersch surgery alone has been used for a limited number of patients with very high operative risk [17, 18]. The combined Delorme-Thiersch procedure removes the bundle of the rectum through the Delorme’s procedure and corrects the patulous anus by Thiersch encirclement to prevent recurrence.…”

Artificial Muscle Devices: Innovations and Prospects for Fecal Incontinence Treatment

“…Devices, which require a partially functioning continence organ and reinforce the functionality of the sphincter muscles, are summarized together selected Refs. 8 , 9 , 36 , 48 , 49 in Table 1 . The sacral nerve stimulation (SNS) has become a standard operative procedure for the treatment of fecal incontinence.…”

“…FENIX ® ) Fascia Tendon Silk Nylon Teflon © Silicone Anal encirclement by bands. Passive increase in pressure around the canal Elongates elastically, widens canal for rectal emptying Complete continence without leakage: 18–75% Principal adverse events: Sling breakage, skin erosion/infection Total explantation rate 25–39% 8 , 9 Lack of randomized controlled trials (RCTs) and long-term studies do not allow any recommendation to be made FENIX ® : Titanium beads with magnetic cores linked by titanium wires Anal encirclement by magnetic band Attractive magnetic forces between beads decrease with increasing bead separation Clinical response a is 0–9% Principal adverse events: pain, infection, bleeding, and fecal impaction Investigational device Randomized clinical trials (RCT) started at end of 2013 in France and UK (estimated patient size of 156 and 250 patients) Sacral nerve stimulation (SNS) or sacral neuromodulation Low amplitude electrical impulses stimulate the sacral nerve, which activates pelvic floor musculature The exact mechanism underlying the improvement in continence achieved by SNS is actually unclear Intention-to-treat success rate b : 63% in the short term 59 In fact, the definitive SNS system will be implanted only if the test system improves continence of more than 50% Most common complications: Pain and paresthesia Has become a standard operative procedure for the treatment of fecal incontinence Supported by medical committees and authorities worldwide a Clinical response = improvement of >50% in Cleveland Clinic Florida Fecal Incontinence Score b Intention-to-treat success rate = i.e., 50% improvement in incontinence episodes per week …”

Anal encirclement: a surgical technique for faecal incontinence in patients who are not good candidates for more invasive surgery – a video vignette

“…It is an easy and low cost procedure but the technique is not frequently used probably due to the high frequency of sling break and faecal impaction. Devesa and Vicente described anal encirclement in 33 patients with FI. Complications included infection, erosion of the skin and breakage of the sling.…”