The artificial bowel sphincter: a single institution experience over a decade

Area of Science:

• Colorectal Surgery
• Medical Device Technology
• Fecal Incontinence Management

Background:

• Severe fecal incontinence significantly impacts patients' quality of life.
• Conservative management and prior surgical treatments often fail in severe cases.
• The Acticon Neosphincter is an artificial bowel sphincter device for managing fecal incontinence.

Purpose of the Study:

• To report the long-term outcomes of patients implanted with the Acticon Neosphincter.
• To evaluate the safety and efficacy of the device in a consecutive patient series.
• To assess device revision and explantation rates and their associated causes.

Main Methods:

• Prospective database review of 52 patients implanted with 85 devices between May 1996 and Jan 2010.
• Preoperative assessment included anal endosonography, anorectal manometry, and electrophysiologic testing.
• Incontinence (Wexner) and Quality of Life scores were tracked, along with annual anal physiology assessments.

Main Results:

• Mean follow-up was 64.3 months; 50% of patients required revisions, primarily due to cuff leaks (73.1%).
• 26.9% of patients required explantation, mostly due to infection (42.9%).
• Activated devices in 67.3% of patients showed significant improvements in Wexner scores (P < 0.0001) and Quality of Life scores (P = 0.0286).

Conclusions:

• The Acticon Neosphincter can achieve favorable long-term results for fecal incontinence.
• Careful patient selection, meticulous surgical technique, and dedicated surveillance are crucial for success.
• Acceptable rates of revision and explantation can be achieved with appropriate management.