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Open Access 07.05.2024 | short report

Treatment of fecal incontinence—is there a light in the end of the tunnel?

verfasst von: Associate Professor Stefan Riss, MD, FRCS, Dr. Christopher Dawoud, MD

Erschienen in: Wiener klinische Wochenschrift

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Summary

Fecal incontinence (FI) is a common disease with higher incidence rates in the elderly population. Treatment of affected patients remains challenging and ranges from conservative management to surgical techniques. Despite all efforts patients often undergo several therapeutic measurements to achieve reasonable functional improvements.
Although sacral neuromodulation still remains a key therapy with success rates up to 80%, a significant number of patients do not respond sufficiently and require further treatment.
Several artificial bowel sphincter devices exist, which can lead to better functional control in selected patients. Notably, complications after these surgeries do occur frequently and the need for implant replacement is still considerable high.
A novel anal band, developed by Agency for Medical Innovations (A.M.I., Austria) is currently under evaluation. This device, composed of silicone and polyester, is placed around the anus outside the external sphincter muscle complex aiming to improve stool continence via mechanical pressure. Early results of this new operation are eagerly awaited.
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Short report

Fecal incontinence is a devastating disease with a high physical and mental burden for those who are affected [1]. It is still considered a taboo topic; thus, exact prevalence rates are difficult to obtain. However, current literature suggests an overall prevalence of 8.3%, with increasing numbers in elderly patients [2].
The etiology of FI is multifactorial and several causes often contribute to the development of the involuntary control of feces [2]. Notably, in order to choose an appropriate treatment a careful diagnostic work up is essential.
Conservative management, including dietary changes, medication for stool regulation, pelvic floor exercises, should be offered primarily and can be beneficial in patients with milder forms of FI. Noteworthy, a higher number of patients continue to suffer from the inability to control stool and require further and more invasive therapies.
Unfortunately, available operations are limited and healing rates are still moderate. Sacral neuromodulation can be regarded as a key treatment modality with success rates reaching up to 80% in patients with FI [3]. Due to the fact, that not all patients respond adequately to electric stimulation, a test phase is required before definite implantation [4]. The Sphinkeeper®, the successor of the Gatekeeper®, represents another technique to treat patients with primarily passive FI [5]. Although, up to ten implants are placed in a circular fashion into the intersphincteric groove, only around half of the patients benefit from this type of therapy [6].
Artificial bowel sphincter has also been implanted with good functional success rates, but were associated with considerable complications rates and the frequent need of surgical removal [7].
We are currently conducting an approval study of a novel anal band, produced by Agency for Medical Innovations (A.M.I., Austria) (see Fig. 1). This small, elastic band consists of biocompatible material (silicone and polyester) and is placed around the anus outside the external sphincter muscle complex. The implantation is performed through two 2‑centimeter incisions at 3‑ and 9‑o’clock lithotomy position. The aim of this innovative technique is to achieve a better functional control by increased mechanical pressure. At the same time, defecation should still be possible, without the necessity of deflating a balloon as it was required in previous implants [8]. The use of a minimally invasive implantation technique and the use of a new material should also reduce the infection rates and subsequently the number of device replacements. Together with A.M.I., J.M. Devesa has been involved in developing the new medical product, which was also based on a previous experience using a Flat Drain Type Jakson-Pratt® for the purpose of anal encirclement [9]. In that study, a considerable number of patients required an explant of the device, which was mainly necessary due to the breakdown of the product itself. Consequently, it might be possible that the new silicon band overcomes these limitations and offers a significant better outcome.
If this simple and new technique is a potential candidate to improve the burden of patients with FI too is still unclear. First results are eagerly awaited and can possibly expected to be available in summer 2024.

Conflict of interest

S. Riss and C. Dawoud declare that they have no competing interests.
Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://​creativecommons.​org/​licenses/​by/​4.​0/​.

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Literatur
1.
Zurück zum Zitat Damon H, Schott AM, Barth X, Faucheron JL, Abramowitz L, Siproudhis L, et al. Clinical characteristics and quality of life in a cohort of 621 patients with faecal incontinence. Int J Colorectal Dis. 2008;23(9):845–51.CrossRefPubMed Damon H, Schott AM, Barth X, Faucheron JL, Abramowitz L, Siproudhis L, et al. Clinical characteristics and quality of life in a cohort of 621 patients with faecal incontinence. Int J Colorectal Dis. 2008;23(9):845–51.CrossRefPubMed
2.
Zurück zum Zitat Whitehead WE, Borrud L, Goode PS, Meikle S, Mueller ER, Tuteja A, et al. Fecal incontinence in US adults: epidemiology and risk factors. Gastroenterology. 2009;137(2):512–7, 7 e1–2. Whitehead WE, Borrud L, Goode PS, Meikle S, Mueller ER, Tuteja A, et al. Fecal incontinence in US adults: epidemiology and risk factors. Gastroenterology. 2009;137(2):512–7, 7 e1–2.
3.
Zurück zum Zitat Kasiri MM, Mittlboeck M, Dawoud C, Riss S. Technical and functional outcome after sacral neuromodulation using the “H” technique. Wien Klin Wochenschr. 2023;135(15-16:399–405.CrossRef Kasiri MM, Mittlboeck M, Dawoud C, Riss S. Technical and functional outcome after sacral neuromodulation using the “H” technique. Wien Klin Wochenschr. 2023;135(15-16:399–405.CrossRef
4.
Zurück zum Zitat Dawoud C, Reissig L, Muller C, Jahl M, Harpain F, Capek B, et al. Comparison of surgical techniques for optimal lead placement in sacral neuromodulation: a cadaver study. Tech Coloproctol. 2022;26(9):707–12.CrossRefPubMedPubMedCentral Dawoud C, Reissig L, Muller C, Jahl M, Harpain F, Capek B, et al. Comparison of surgical techniques for optimal lead placement in sacral neuromodulation: a cadaver study. Tech Coloproctol. 2022;26(9):707–12.CrossRefPubMedPubMedCentral
5.
Zurück zum Zitat Dawoud C, Widmann KM, Pereyra D, Harpain F, Riss S. Long-term outcome after SphinKeeper(R) surgery for treating fecal incontinence-who are good candidates? Langenbecks Arch Surg. 2023;408(1):456.CrossRefPubMedPubMedCentral Dawoud C, Widmann KM, Pereyra D, Harpain F, Riss S. Long-term outcome after SphinKeeper(R) surgery for treating fecal incontinence-who are good candidates? Langenbecks Arch Surg. 2023;408(1):456.CrossRefPubMedPubMedCentral
6.
Zurück zum Zitat Dawoud C, Gidl D, Widmann KM, Pereyra D, Harpain F, Kama B, et al. Endosonographic monitoring of Sphinkeeper((R)) prostheses movements: does physical activity have an impact? Updates Surg. 2024;76(1):169–77.CrossRefPubMed Dawoud C, Gidl D, Widmann KM, Pereyra D, Harpain F, Kama B, et al. Endosonographic monitoring of Sphinkeeper((R)) prostheses movements: does physical activity have an impact? Updates Surg. 2024;76(1):169–77.CrossRefPubMed
7.
Zurück zum Zitat Fattorini E, Brusa T, Gingert C, Hieber SE, Leung V, Osmani B, et al. Artificial Muscle Devices: Innovations and Prospects for Fecal Incontinence Treatment. Ann Biomed Eng. 2016;44(5):1355–69.CrossRefPubMedPubMedCentral Fattorini E, Brusa T, Gingert C, Hieber SE, Leung V, Osmani B, et al. Artificial Muscle Devices: Innovations and Prospects for Fecal Incontinence Treatment. Ann Biomed Eng. 2016;44(5):1355–69.CrossRefPubMedPubMedCentral
8.
Zurück zum Zitat Goos M, Baumgartner U, Lohnert M, Thomusch O, Ruf G. Experience with a new prosthetic anal sphincter in three coloproctological centres. BMC Surg. 2013;13:45.CrossRefPubMedPubMedCentral Goos M, Baumgartner U, Lohnert M, Thomusch O, Ruf G. Experience with a new prosthetic anal sphincter in three coloproctological centres. BMC Surg. 2013;13:45.CrossRefPubMedPubMedCentral
9.
Zurück zum Zitat Devesa JM, Hervas PL, Vicente R, Rey A, Die J, Moreno I, et al. Anal encirclement with a simple prosthetic sling for faecal incontinence. Tech Coloproctol. 2011;15(1):17–22.CrossRefPubMed Devesa JM, Hervas PL, Vicente R, Rey A, Die J, Moreno I, et al. Anal encirclement with a simple prosthetic sling for faecal incontinence. Tech Coloproctol. 2011;15(1):17–22.CrossRefPubMed
Metadaten
Titel
Treatment of fecal incontinence—is there a light in the end of the tunnel?
verfasst von
Associate Professor Stefan Riss, MD, FRCS
Dr. Christopher Dawoud, MD
Publikationsdatum
07.05.2024
Verlag
Springer Vienna
Erschienen in
Wiener klinische Wochenschrift
Print ISSN: 0043-5325
Elektronische ISSN: 1613-7671
DOI
https://doi.org/10.1007/s00508-024-02369-7