[Dynamic graciloplasty vs artificial bowel sphincter in the management of severe fecal incontinence].
Dynamic graciloplasty (DGP) and the Acticon Neosphincter (artificial bowel sphincter, ABS) are well-established therapeutic instruments in patients with severe fecal incontinence. However, the success rates in the literature must be interpreted with caution. The report presented here presents firstly a critical analysis of 1510 patients in 52 studies (29 DGP vs 23 ABS). The evidence of these studies was assessed using the Oxford EBM criteria. All data were statistically analysed. Up to 94% of the studies analysed show EBM levels of only >3b. Both procedures show significant improvements in postoperative continence scores (p<0.001) and a significant advantage of ABS over DGP. Nevertheless, they are associated with a high incidence of morbidity in the long term (infection rate ABS vs DGP 21.74% vs 35.1%, revision rate ABS vs DGP 37.53% vs 40.64%, and ABS explantation rates of 30%). Presently no therapeutic recommendation can be expressed based on the few data available. Furthermore, therapy should be performed in specialized centers and patients should be given a realistic picture of the critical outcome of both surgical techniques.
Ruthmann
O
O
Abteilung für Allgemein- und Viszeralchirurgie, Universitätsklinikum Freiburg, Hugstetter Strasse 55, 79106 Freiburg im Breisgau.
Fischer
A
A
Hopt
U T
UT
Schrag
H J
HJ
D001003:Anal Canal / Q000601:surgery*; D004599:Electric Stimulation Therapy; D019544:Equipment Failure Analysis; D019317:Evidence-Based Medicine; D005242:Fecal Incontinence / Q000209:etiology / Q000601:surgery*; D005500:Follow-Up Studies; D006801:Humans; D018482:Muscle, Skeletal / Q000637:transplantation*; D010043:Outcome and Process Assessment, Health Care; D011183:Postoperative Complications / Q000209:etiology; D019736:Prostheses and Implants; D011474:Prosthesis Design