Surgery for faecal incontinence in adults

Area of Science:

• Gastroenterology
• Colorectal Surgery
• Pelvic Floor Disorders

Background:

• Faecal incontinence significantly impacts quality of life, with surgical interventions offering potential solutions.
• Current treatments range from conservative measures to complex surgical repairs of the sphincter complex.
• Surgical options aim to correct defects, augment function, or replace non-functioning sphincters.

Purpose of the Study:

• To evaluate surgical techniques for adult faecal incontinence, excluding rectal prolapse.
• To compare surgical management against non-surgical approaches.
• To compare the efficacy of various surgical interventions against each other.

Main Methods:

• A systematic review of randomized and quasi-randomized controlled trials was conducted.
• Searches included major databases (Cochrane, PubMed, EMBASE) and handsearches of key journals and conference proceedings.
• Primary outcomes included changes in incontinence, achievement of continence, and faecal urgency.

Main Results:

• Nine trials with 264 participants were included; only two compared surgery with non-surgical management.
• Artificial bowel sphincter insertion showed improvement but with high morbidity.
• Seven trials compared surgical techniques, but most lacked sufficient data for definitive conclusions, with no statistically significant differences found between most procedures.

Conclusions:

• The current evidence base for surgical treatments of faecal incontinence is limited by small trial sizes and methodological weaknesses.
• It is not possible to definitively recommend one surgical procedure over another based on available data.
• Larger, high-quality trials are necessary, and optimal treatment may involve combined surgical and non-surgical approaches.