title: Outcomes of Reimplantation of the Artificial Bowel Sphincter.
abstract: BACKGROUND
  Outcomes of artificial bowel sphincter reimplantation for severe fecal incontinence remain unknown.
  
  
  OBJECTIVE
  The purpose of this study was to evaluate the feasibility and outcomes of artificial bowel sphincter reimplantation versus implantation.
  
  
  METHODS
  This was a retrospective review study.
  
  
  METHODS
  The study was conducted at a single institution.
  
  
  METHODS
  Patients with severe incontinence who underwent de novo implantation and re-implantation between January 1998 and December 2012 were included.
  
  
  METHODS
  Complications, length of functional device time, success rates (functioning device at follow-up), patient demographics, comorbidities, etiology of incontinence, operative data, postoperative complications, and outcomes of initial implantation versus reimplantation were analyzed.
  
  
  RESULTS
  A total of 57 patients (mean age, 49.3 ± 13.5 years; 44 women) underwent implantation. Sixteen (28%) succeeded and 41 (72%) failed, requiring explantation; 17 of 41 patients underwent reimplantation; 5 had 2 reimplantations. There were 79 implantations and 50 explantations (63.3%) in total. Implantation and reimplantation procedures had similar lengths of operation, hospital stay, postoperative complications, and explantation rate. Most common reasons for device explantation were infection/erosion (27/50 (54%)) and malfunction (19/50 (38%)). Reasons for reimplantation included device malfunction/migration (17/22 (77.3%)) and/or infection/erosion (5/22 (22.7%)). Seven (41.2%) of 17 patients for whom reimplantation was attributed to noninfectious reasons had a functioning device, whereas only 1 (20.0%) of 5 who had reimplantation because of infection/erosion had a working device. At a median follow-up of 29.5 months (range, 1.0-215.0 months), 24 patients (42%) retained a functioning device (implantation = 16; reimplantation = 8). Success rates were not significantly different between initial implantation and reimplantation procedures (p = 0.755). There were no differences in the length of functional device time between implanted and reimplanted devices (p = 0.439).
  
  
  CONCLUSIONS
  The study was limited by its retrospective nature and small sample size.
  
  
  CONCLUSIONS
  Artificial bowel sphincter implantation has a high failure rate, requiring explantation in 72% of patients in this study. Reimplantation was often possible, with a success rate of 47%. Selected reimplantation for noninfectious complications had better outcomes than did reimplantation for septic causes. Short- and long-term outcomes are comparable to initial implantation.
authors.affiliation: 1 Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, Florida 2 Department of Colorectal Surgery, Guang'anmen Hospital China Academy of Chinese Medical Sciences, Beijing, China.
authors.forename: Xiaofeng
authors.initials: X
authors.lastname: Wang
authors.forename: Giovanna
authors.initials: G
authors.lastname: DaSilva
authors.forename: David J
authors.initials: DJ
authors.lastname: Maron
authors.forename: Alejandro J
authors.initials: AJ
authors.lastname: Cracco
authors.forename: Steven D
authors.initials: SD
authors.lastname: Wexner
mesh_terms: D000328:Adult; D001003:Anal Canal / Q000503:physiopathology / Q000601:surgery; D001187:Artificial Organs / Q000009:adverse effects*; D020878:Device Removal / Q000379:methods; D013505:Digestive System Surgical Procedures / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data; D005242:Fecal Incontinence / Q000209:etiology / Q000601:surgery; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D008910:Minnesota; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications / Q000453:epidemiology*; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data; D020127:Recovery of Function; D012086:Reoperation / Q000379:methods / Q000706:statistics & numerical data; D012189:Retrospective Studies