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Management of Fecal Incontinence: Surgical Treatment Options.

Birgit Bittorf1, Klaus E Matzel1

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Summary

Fecal incontinence (FI) treatment focuses on surgery when conservative options fail. Sacral neuromodulation (SNM) is the preferred, minimally invasive surgical option for most FI cases, offering high success rates.

Keywords:
Fecal incontinenceSacral neuromodulationSphincteroplasty

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Area of Science:

  • Gastroenterology
  • Colorectal Surgery
  • Neuromodulation

Background:

  • Fecal incontinence (FI) is a prevalent and often overlooked adult health concern.
  • Nonsurgical treatments are the primary approach, with surgery reserved for cases refractory to conservative management.
  • This overview examines historical and contemporary surgical interventions for FI.

Purpose of the Study:

  • To review the evolution of surgical treatments for fecal incontinence.
  • To compare the efficacy and indications of current surgical procedures.
  • To highlight sacral neuromodulation (SNM) as a leading treatment modality.

Main Methods:

  • Review of historical and current surgical techniques for FI.
  • Analysis of guideline-recommended procedures.
  • Evaluation of efficacy, invasiveness, and comorbidity of treatments.

Main Results:

  • Dynamic graciloplasty and artificial bowel sphincter are largely obsolete due to invasiveness and complications.
  • Sphincteroplasty and sacral neuromodulation (SNM) are current guideline recommendations.
  • SNM demonstrates high efficacy with minimal invasiveness, becoming the first choice for various FI causes, including morphological defects.

Conclusions:

  • Surgical options for FI are limited.
  • Sacral neuromodulation (SNM) is the gold standard for treating multiple FI conditions due to its efficacy and low comorbidity.
  • Sphincteroplasty remains a viable option for FI specifically resulting from anal sphincter lesions.