Standards for anal sphincter replacement.
OBJECTIVE
Anal sphincter replacement offers a new treatment option for patients with severe refractory fecal incontinence or for those who require abdominoperineal resection for localized malignancy. The purpose of this study was to review the current status of anal sphincter replacement, formulate a consensus statement regarding its current use, and outline suggestions for future development.


METHODS
Four areas of interests were selected: indications for sphincter replacement, continence scoring and quality of life, choice of therapy, and dissemination of new technology. A questionnaire regarding these issues was developed and circulated to working party members; its results served as the basis for this consensus document.


RESULTS
Both electrically stimulated skeletal muscle neosphincter and artificial anal sphincter are options for patients with end-stage fecal incontinence. Electrically stimulated skeletal muscle neosphincter is also appropriate for reconstruction after surgical excision of the anorectum in selected cases. Avoidance of complications requires strict attention to sterile technique, prophylactic antibiotics, and deep venous thrombus prophylaxis. A standardized scoring system is proposed that evaluates both continence and evacuation. Quality of life is a critical endpoint for assessing sphincter replacement, and use of The American Society of Colon and Rectal Surgeons incontinence-specific quality-of-life instrument is recommended. As the efficacy of sphincter replacement becomes proven, dissemination of the technique should occur in a controlled manner to ensure adequate surgeon training, minimization of complications, and optimization of results.


CONCLUSIONS
Sphincter replacement by electrically stimulated skeletal muscle neosphincter and artificial anal sphincter provide a continent option for patients with end-stage fecal incontinence and those requiring abdominoperineal resection. The guidelines offered in this document are intended to facilitate the controlled and safe development and acceptance of these new techniques.
Madoff
R D
RD
Division of Colon and Rectal Surgery, University of Minnnesota Medical School, Minneapolis, USA.
Baeten
C G
CG
Christiansen
J
J
Rosen
H R
HR
Williams
N S
NS
Heine
J A
JA
Lehur
P A
PA
Lowry
A C
AC
Lubowski
D Z
DZ
Matzel
K E
KE
Nicholls
R J
RJ
Seccia
M
M
Thorson
A G
AG
Wexner
S D
SD
Wong
W D
WD
D001003:Anal Canal / Q000601:surgery*; D001187:Artificial Organs; D013505:Digestive System Surgical Procedures / Q000379:methods / Q000592:standards*; D004558:Electric Stimulation; D005242:Fecal Incontinence / Q000601:surgery*; D006801:Humans; D008160:Lumbosacral Plexus / Q000502:physiology; D018482:Muscle, Skeletal / Q000294:innervation / Q000502:physiology / Q000637:transplantation; D018579:Patient Selection; D017410:Practice Guidelines as Topic; D011788:Quality of Life; D019651:Plastic Surgery Procedures / Q000592:standards*