Artificial bowel sphincter

Abstract

Fecal incontinence is a socially devastating problem. The treatment algorithm depends on the etiology of the disease. Large anal sphincter defects can be treated by sphincter replacement procedures: the dynamic graciloplasty and the artificial bowel sphincter (ABS). The best indications for the ABS are lesions of the anal sphincters that are inaccessible to local repair and not responsive to sacral nerve stimulation test or not indicated for such a test. A recent article that published experiences with the ABS showed that this technique had a high rate of morbidity, surgical reinterventions, and explants. Complications leading to explantation included perioperative infections, failure of wound healing, erosion of part of the device throughout the skin or the anal canal, late infection, and mechanical malfunction of the device due to cuff or balloon rupture. The ABS is suitable for well-motivated, selected patients with fecal incontinence of more than one year's duration and whose condition is affected by an important personal, familial, and/or social disability. © 2010 Springer-Verlag Milan.