Artificial Bowel Sphincter for Fecal Incontinence

Lee, Kil Yeon

Abstract

Fecal incontinence is a common disorder, affecting all ages and both sexes. It is a devastating condition and has a major impact on quality of life. The level of treatment must be appropriate for the severity of symptoms. Nonsurgical techniques are appropriate for patients with minor degrees of incontinence. Patients with sphincter disruption or rectal prolapse can benefit from the appropriate surgical therapy. Patients with intractable, clinically significant fecal incontinence, caused by trauma or the failure of surgical therapy, need salvage options. In the past if a patient was not amenable to a tissue repair or failed a tissue repair, a colostomy was his or her only surgical option. However, new innovations can give patients more options to regain continence. The artificial bowel sphincter (ABS) is one of those newer options. It is an implantable device used to treat the patients with severe fecal incontinence, who have failed, or are not candidates for less invasive forms of restorative therapy. It is intended to mimic the natural process of bowel control. This device is reserved for patients with severe fecal incontinence that is not amenable to lesser forms of therapy. Because it is an artificial device, ABS is unfortunately associated with high morbidity and low success rate. With experience, however, the infection rate has declined due to new standardized prophylactic antibiotics regimen. Therefore, the ABS has become a good option for patients with severe fecal incontinence. The results are quite impressive with a significant number of patients obtaining complete continence. This review presents the technique of ABS implantation and the current status of ABS.