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Standards for anal sphincter replacement.

R D Madoff1, C G Baeten, J Christiansen

  • 1Division of Colon and Rectal Surgery, University of Minnnesota Medical School, Minneapolis, USA.

Diseases of the Colon and Rectum
|March 4, 2000
PubMed
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Anal sphincter replacement, using muscle neosphincters or artificial devices, offers a new treatment for fecal incontinence. Guidelines are provided for safe development and acceptance of these advanced surgical techniques.

Area of Science:

  • Surgical innovation in proctology and reconstructive surgery.
  • Gastroenterology and colorectal surgery advancements.

Background:

  • Severe fecal incontinence and the need for abdominoperineal resection present significant challenges.
  • Existing treatment options for these conditions are often limited or ineffective.

Purpose of the Study:

  • To review the current status of anal sphincter replacement techniques.
  • To establish a consensus on the current use of anal sphincter replacement.
  • To propose future directions for the development of anal sphincter replacement.

Main Methods:

  • A working party identified key areas: indications, scoring, quality of life, therapy choice, and technology dissemination.
  • A questionnaire was developed and distributed to working party members.

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  • The results informed the development of this consensus document.

    • Main Results:

    • Electrically stimulated skeletal muscle neosphincter and artificial anal sphincter are viable options for end-stage fecal incontinence.
    • Neosphincters are also suitable for reconstruction post-anorectal excision.
    • Strict sterile technique, antibiotics, and DVT prophylaxis are crucial for complication avoidance.
    • A standardized scoring system for continence and evacuation is proposed.
    • Quality of life assessment using a specific instrument is recommended.
    • Controlled dissemination ensures surgeon training and optimal outcomes.

    Conclusions:

    • Anal sphincter replacement offers a continent solution for end-stage fecal incontinence and post-abdominoperineal resection.
    • The developed guidelines aim to promote the safe and controlled adoption of these novel techniques.