Anal encirclement with a simple prosthetic sling for faecal incontinence

Millions of people suffer from anal incontinence not currently treated due to the complexity and cost of the surgical techniques in use. The purpose of this report is to evaluate the results of anal encirclement with a simple device in a group of patients with faecal incontinence of multiple causes.

Surgery was performed as a modified Thiersch procedure through minimal perianal incisions, and a flat band of silicone was introduced to encircle the anus. Results were assessed by clinical response and objectively evaluated by comparing pre- and post-operative manometry, Jorge-Wexner and QOL (Rockwood) scores.

Over a period of 5 years, this procedure was performed in 20 women and 13 men, mean age 54 years (27-86 years). Causes of incontinence were iatrogenic (5), obstetric (5), idiopathic (5), restorative proctectomy (5), rectal prolapsed (4), congenital (4), neuropathic (3), trauma (1) and mixed (1). Mortality was nil and morbidity was related to early infection (n = 2) and late skin erosion/infection (n = 2). Early or late breaking of the sling occurred in nine patients, due to the inappropriate method of closing the device. There were 13 explants: 3 as definitive and 10 re-implantations. All but one patient improved the clinical status which was objectively assessed by Jorge-Wexner and QOL scores, with significant differences.

This simple, safe and low-cost technique is useful for treating from disturbing soiling to severe incontinence in all those patients with failed sphincteroplasty or not amenable to sphincter repair. However, a proper device needs to be designed.