Surgical approaches to fecal incontinence in the adult.
Surgical treatment of anal incontinence is indicated only for patients who have failed medical treatment. Sphincterorraphy is suitable in case of external sphincter rupture. In the last decade, sacral nerve stimulation has proven to be a scientifically validated solution when no sphincter lesion has been identified and more recently has also been proposed as an alternative in cases of limited sphincter defect. Anal reconstruction using artificial sphincters is still under evaluation in the literature, while indications for dynamic graciloplasty are decreasing due to its complexity and high morbidity. Less risky techniques involving intra-sphincteric injections are being developed, with encouraging preliminary results that need to be confirmed especially in the medium- and long-term. Antegrade colonic enemas instilled via cecostomy (Malone) can be an alternative to permanent stoma in patients who are well instructed in the techniques of colonic lavage. Stomal diversion is a solution of last resort.
Clinique de chirurgie digestive et endocrinienne, institut des maladies de l'appareil digestif, CHU Nantes, Hôtel Dieu, 1, place A.-Ricordeau, 44000 Nantes, France. Electronic address: guillaume.meurette@chu-nantes.fr.
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Meurette
Clinique de chirurgie digestive et endocrinienne, institut des maladies de l'appareil digestif, CHU Nantes, Hôtel Dieu, 1, place A.-Ricordeau, 44000 Nantes, France.
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Duchalais
Clinique de chirurgie digestive et endocrinienne, institut des maladies de l'appareil digestif, CHU Nantes, Hôtel Dieu, 1, place A.-Ricordeau, 44000 Nantes, France.
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Lehur
D000328:Adult; D001003:Anal Canal / Q000601:surgery; D002431:Cecostomy; D003125:Colostomy; D004599:Electric Stimulation Therapy; D005242:Fecal Incontinence / Q000601:surgery* / Q000628:therapy; D006801:Humans; D016896:Treatment Outcome
Anal incontinence; Antegrade colonic enema; Artificial sphincter; Intra-sphincteric injection; Sacral neurostimulation; Sphincterorraphy