Surgical therapies for fecal incontinence.
OBJECTIVE
Fecal incontinence is a significant source of morbidity and decreased quality of life (QOL) for many. Until recent years, few therapies beyond medical management were available for patients. Surgical treatment of fecal incontinence has evolved from colostomy and direct repair of muscle defects to interventional techniques such as nerve stimulation and bulking agents. We review the most recent surgical options for the treatment of fecal incontinence within the context of established therapies.


RESULTS
Overlapping sphincteroplasty is an established therapy that improves continence and QOL, although results deteriorate over time. Implanted artificial bowel sphincter has a 100% complication rate and 80% are explanted over time. Sacral nerve stimulation has minimal risk and more durable long-term improvement in continence. Less invasive versions of nerve stimulation are being researched. Injectable biomaterials have shown some promise, although durability of results is not clear. Novel therapies, including muscle cell transfer and pelvic slings are currently being investigated.


CONCLUSIONS
Surgical therapies for fecal incontinence continue to evolve and show promise in improving QOL with a lower risk profile. Effective valuation of these therapies is currently limited by heterogeneous studies, short duration of follow up, and inconsistent outcome measures.
Beth Israel Deaconess Medical Center, Division of Colorectal Surgery, Boston, Massachusetts, USA.
Prathima
P
Nandivada
Deborah
D
Nagle
D001003:Anal Canal / Q000601:surgery; D001672:Biocompatible Materials / Q000627:therapeutic use; D004599:Electric Stimulation Therapy / Q000379:methods; D005242:Fecal Incontinence / Q000601:surgery* / Q000628:therapy; D006801:Humans; D019736:Prostheses and Implants; D013127:Spinal Nerves
D001672:Biocompatible Materials