title: Artificial Muscle Devices: Innovations and Prospects for Fecal Incontinence Treatment.
abstract: Fecal incontinence describes the involuntary loss of bowel content, which is responsible for stigmatization and social exclusion. It affects about 45% of retirement home residents and overall more than 12% of the adult population. Severe fecal incontinence can be treated by the implantation of an artificial sphincter. Currently available implants, however, are not part of everyday surgery due to long-term re-operation rates of 95% and definitive explantation rates of 40%. Such figures suggest that the implants fail to reproduce the capabilities of the natural sphincter. This article reviews the artificial sphincters on the market and under development, presents their physical principles of operation and critically analyzes their performance. We highlight the geometrical and mechanical parameters crucial for the design of an artificial fecal sphincter and propose more advanced mechanisms of action for a biomimetic device with sensory feedback. Dielectric electro-active polymer actuators are especially attractive because of their versatility, response time, reaction forces, and energy consumption. The availability of such technology will enable fast pressure adaption comparable to the natural feedback mechanism, so that tissue atrophy and erosion can be avoided while maintaining continence during daily activities.
authors.affiliation: Department of Surgery and Orthopedics, Hospitals Schaffhausen, 8200, Schaffhausen, Switzerland.|Biomaterials Science Center, University of Basel, 4123, Allschwil, Switzerland.
authors.forename: Elisa
authors.initials: E
authors.lastname: Fattorini
authors.affiliation: Institute for Surgical Technology & Biomechanics, University of Bern, 3014, Bern, Switzerland.
authors.forename: Tobia
authors.initials: T
authors.lastname: Brusa
authors.affiliation: Department of Surgery and Orthopedics, Hospitals Schaffhausen, 8200, Schaffhausen, Switzerland.|Department of Medicine, University of Witten/Herdecke, 58448, Witten, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Gingert
authors.affiliation: Biomaterials Science Center, University of Basel, 4123, Allschwil, Switzerland.
authors.forename: Simone E
authors.initials: SE
authors.lastname: Hieber
authors.affiliation: Biomaterials Science Center, University of Basel, 4123, Allschwil, Switzerland.
authors.forename: Vanessa
authors.initials: V
authors.lastname: Leung
authors.affiliation: Biomaterials Science Center, University of Basel, 4123, Allschwil, Switzerland.
authors.forename: Bekim
authors.initials: B
authors.lastname: Osmani
authors.affiliation: Department of Surgery and Orthopedics, Hospitals Schaffhausen, 8200, Schaffhausen, Switzerland.|Biomaterials Science Center, University of Basel, 4123, Allschwil, Switzerland.
authors.forename: Marco D
authors.initials: MD
authors.lastname: Dominietto
authors.affiliation: Institute for Surgical Technology & Biomechanics, University of Bern, 3014, Bern, Switzerland.
authors.forename: Philippe
authors.initials: P
authors.lastname: Büchler
authors.affiliation: Department of Surgery and Orthopedics, Hospitals Schaffhausen, 8200, Schaffhausen, Switzerland.
authors.forename: Franc
authors.initials: F
authors.lastname: Hetzer
authors.affiliation: Biomaterials Science Center, University of Basel, 4123, Allschwil, Switzerland. bert.mueller@unibas.ch.
authors.forename: Bert
authors.initials: B
authors.lastname: Müller
mesh_terms: D000328:Adult; D001003:Anal Canal; D001187:Artificial Organs; D040761:Biomimetic Materials; D005242:Fecal Incontinence / Q000503:physiopathology / Q000601:surgery; D006801:Humans; D011474:Prosthesis Design; D011475:Prosthesis Failure
keywords: Biomimetic design; Electro-active polymer actuator; Fecal sphincter