Systematic review of perianal implants in the treatment of faecal incontinence

Background: Injectable bulking agents have been used with varying success for the treatment of faecal incontinence. This systematic review aimed to investigate the various injectable agents and techniques used for the treatment of faecal incontinence, and to assess their safety and efficacy. Methods: Thirty-nine publications were identified and studied. The following variables were pooled for univariable analysis: type, location, route of bulking agents, and the use of ultrasound guidance, antibiotics, laxatives and anaesthetics. Predictors of the development of complications and successful outcomes were identified by multivariable logistic regression analysis. Results: A total of 1070 patients were included in the analysis. On multivariable analysis, the only significant predictor of the development of complications was the route of injection of bulking agents (odds ratio 3.40, 95 per cent confidence interval 1.62 to 7.12; P = 0.001). Two variables were significant predictors of a successful short-term outcome: the use of either PTQ (R) (OR 5.93, 2.21 to 16.12; P = 0.001) or Coaptite (R) (OR 10.74, 1.73 to 65.31; P = 0.001) was associated with a greater likelihood of success. Conversely, the use of local anaesthetic was associated with a lower likelihood of success (OR 0.18, 0.05 to 0.59; P = 0.005). Failure to use laxatives in the postoperative period resulted in a poorer medium-to longer-term outcome (OR 0.13, 0.06 to 0.25; P = 0.001). Conclusion: This systematic review has identified variations in the practice of injection of bulking agents that appear to influence the likelihood of complications and affect the outcomes after treatment.