Surgery for faecal incontinence in adults

Area of Science:

• Gastroenterology
• Colorectal Surgery
• Pelvic Floor Disorders

Background:

• Faecal incontinence presents significant challenges, impacting quality of life.
• Current treatments include conservative methods and surgical interventions.
• Surgery is indicated for correctable structural or functional defects in the pelvic floor or anal sphincter.

Purpose of the Study:

• To evaluate established surgical techniques for adult faecal incontinence without rectal prolapse.
• To compare surgical versus non-surgical management.
• To compare different surgical techniques against each other.

Main Methods:

• Systematic review of randomized and quasi-randomized trials.
• Searched multiple databases (Cochrane, Medline, Embase) and hand-searched key journals.
• Included trials focused on adult faecal incontinence surgery, excluding rectal prolapse surgery.

Main Results:

• Four trials with 110 participants were included; none compared surgery to non-surgical management.
• Two trials compared pelvic floor repair techniques; one added sphincter plication; one compared neosphincter to pelvic floor repair.
• No significant differences in primary outcomes were detected, with limited and inconsistently reported data.

Conclusions:

• The review is limited by a small number of trials, small sample sizes, and methodological weaknesses.
• It is not possible to identify clinically significant differences between surgical procedures.
• Larger, rigorous trials are essential to guide clinical practice for faecal incontinence surgery.