Technical and Functional Results of the Artificial Bowel Sphincter for Treatment of Severe Fecal Incontinence: Is There Any Benefit for the Patient?

BACKGROUND: Fecal incontinence is a socially devastating problem that can be cured by the artificial bowel sphincter in selected cases. OBJECTIVE: This study evaluates short- and long-term morbidity and functional results of the artificial bowel sphincter. DESIGN: This study is a retrospective evaluation of consecutive patients. SETTINGS: This study was conducted at 2 academic colorectal units. PATIENTS: Between May 2003 and July 2010, all consecutive patients who underwent artificial bowel sphincter implantation for severe fecal incontinence were included in the study. INTERVENTION: The artificial bowel sphincter was implanted through 2 incisions made in the perineum and suprapubic area. MAIN OUTCOME MEASURES: Patients were reviewed at months 1, 6, and 12, and then annually. Mortality, morbidity (early infection within the first 30 days after implant, and late thereafter), and reoperations including explantations were analyzed. Anal continence was evaluated by means of the Cleveland Clinic Florida score. Mean follow-up was 38 months (range, 12-98). RESULTS: Between May 2003 and July 2010, 21 consecutive patients with a mean age of 51 years (range, 23-71) underwent surgery. There was no mortality. All patients presented with at least 1 complication. Infection or cutaneous ulceration occurred in 76% of patients, perineal pain in 29%, and rectal evacuation disorders in 38%. The artificial bowel sphincter was definitely explanted from 17 patients (81%). The artificial sphincter was able to be activated in 17 patients (81%), and continence was satisfactory at 1 year in those who still had their sphincter in place (n = 12). CONCLUSION: There is a very high rate of morbidity and explantation after implantation of an artificial bowel sphincter for fecal incontinence. Four of 21 patients who still had an artificial sphincter in place had satisfactory continence at a mean follow-up of 38 months.