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Open Access Research article

Experience with a new prosthetic anal sphincter in three coloproctological centres

Matthias Goos1*, Ulrich Baumgartner2, Mathias Löhnert3, Oliver Thomusch1 and Günther Ruf1

Author Affiliations

1 Department for General and Visceral Surgery, University Hospital Freiburg im Breisgau, Hugstetter Straße 55, 79106, Freiburg im Breisgau, Baden-Württemberg, Germany

2 Department for General and Visceral Surgery and Coloproctology, County Hospital Emmendingen, Emmendingen, Germany

3 Department for General and Visceral Surgery and Coloproctology, Hospital Rosenhöhe Bielefeld, Bielefeld, Germany

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BMC Surgery 2013, 13:45  doi:10.1186/1471-2482-13-45

Published: 8 October 2013

Abstract

Background

Fecal incontinence is a common and severely disabling disorder. For patients with severe fecal incontinence, surgery may prove to be the only adequate treatment option.

Methods

This study reports on 43 patients that were treated with a prosthetic sphincter system between 2005 and 2009 in three coloproctological centres. Main Outcome Measures: complications, anal pressures before and after surgery, fecal continence score.

Results

The new artificial sphincter system significantly improves continence but leads to some complications in clinical practice. After implantation of the device, continence improved significantly (Keller & Jostarndt continence score 2.6 to 14.3 (P < 0.01)). With the band activated, resting pressure improved significantly as compared to baseline (10.7 mmHg vs. 66.1 mm Hg, P < 0.01). The same holds for anal sphincter squeeze pressure (32.2 mmHg versus 85.9 mm Hg, P < 0.01). Complications occurred in 21 patients (48.8%): 10 surgical and 13 technical. Two patients were affected by both technical and surgical problems. The median time of the occurrence was 3 months postop. In five patients difficulties arose within the first postoperative month leading to explantation of the device in three patients. 90% of complications occurred in the first year.

Conclusions

The soft anal band of AMI (AAS), a new artificial anal sphincter, improves severe anal incontinence, but it must be regarded as a last treatment option to avoid a stoma.

Keywords:
Fecal incontinence; Prosthetic sphincter; Treatment option