Results of Traditional Surgical Treatment for Fecal Incontinence

The most common surgical treatment for fecal incontinence is sphincteroplasty, but this treatment option requires a localized anatomic sphincter injury and outcomes vary and tend to deteriorate with time. Other surgical techniques have therefore been developed. Postanal repair was designed to restore the anorectal angle with muscle plication of the posterior aspect of the anal canal. Initial improvement rates are acceptable, but only a small proportion of patients reports complete alleviation of symptoms and outcomes deteriorate with time. Suboptimal long-term outcome has lead to decreased use of the procedure. Electrostimulation of a transposed gracilis muscle around the anal canal can yield excellent results in selected patients. Complication rates are high when performed in nonspecialist centers, and the technique is currently not approved in the USA. Artificial bowel sphincter can restore acceptable anal continence and is used for treatment of end-stage fecal incontinence. A problematic high incidence of infection and erosion problems has been reported in some studies, which can hopefully be improved with a more stringent sterile protocol and centralization of the procedure to select specialist centers.