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Outcomes of Reimplantation of the Artificial Bowel Sphincter
Xiaofeng Wang1, Giovanna DaSilva, David J Maron
11 Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, Florida 2 Department of Colorectal Surgery, Guang'anmen Hospital China Academy of Chinese Medical Sciences, Beijing, China.
Background:
Outcomes of artificial bowel sphincter reimplantation for severe fecal incontinence remain unknown.
Objective:
The purpose of this study was to evaluate the feasibility and outcomes of artificial bowel sphincter reimplantation versus implantation.
Design:
This was a retrospective review study.
Settings:
The study was conducted at a single institution.
Patients:
Patients with severe incontinence who underwent de novo implantation and re-implantation between January 1998 and December 2012 were included.
Main Outcome Measures:
Complications, length of functional device time, success rates (functioning device at follow-up), patient demographics, comorbidities, etiology of incontinence, operative data, postoperative complications, and outcomes of initial implantation versus reimplantation were analyzed.
Results:
A total of 57 patients (mean age, 49.3 ± 13.5 years; 44 women) underwent implantation. Sixteen (28%) succeeded and 41 (72%) failed, requiring explantation; 17 of 41 patients underwent reimplantation; 5 had 2 reimplantations. There were 79 implantations and 50 explantations (63.3%) in total. Implantation and reimplantation procedures had similar lengths of operation, hospital stay, postoperative complications, and explantation rate. Most common reasons for device explantation were infection/erosion (27/50 (54%)) and malfunction (19/50 (38%)). Reasons for reimplantation included device malfunction/migration (17/22 (77.3%)) and/or infection/erosion (5/22 (22.7%)). Seven (41.2%) of 17 patients for whom reimplantation was attributed to noninfectious reasons had a functioning device, whereas only 1 (20.0%) of 5 who had reimplantation because of infection/erosion had a working device. At a median follow-up of 29.5 months (range, 1.0-215.0 months), 24 patients (42%) retained a functioning device (implantation = 16; reimplantation = 8). Success rates were not significantly different between initial implantation and reimplantation procedures (p = 0.755). There were no differences in the length of functional device time between implanted and reimplanted devices (p = 0.439).
Limitations:
The study was limited by its retrospective nature and small sample size.
Conclusions:
Artificial bowel sphincter implantation has a high failure rate, requiring explantation in 72% of patients in this study. Reimplantation was often possible, with a success rate of 47%. Selected reimplantation for noninfectious complications had better outcomes than did reimplantation for septic causes. Short- and long-term outcomes are comparable to initial implantation.
