Nuevas alternativas en el tratamiento quirúrgico de la incontinencia fecal grave.

by Ruiz Carmona, Mª Dolores

Abstract (Summary)
ABSTRACT OBJECTIVE: To establish real utility of artificial bowel sphincter, dynamic graciloplasty and sacral nerve stimulation for the treatment of severe fecal incontinence. METHOD: Thirty fecally incontinent patients were included. Group I: 17 patients with median age 46 years with artificial bowel sphincter implantation during November 1996-2002. Group II: 5 patients with median age 42 years with dynamic graciloplasty between January-October 1998. Group III: 8 women with median age 62 years with sacral neuromodulation during February 2001October 2003. RESULTS: Group I: Mean follow-up 42 months. Morbidity in 94% of patients. After first implant 9 devices were explanted (53%), with reimplantation in 5 of these. Wexner score, quality of life and anal pressures with cuff closed improved significantly after implant. Group II: Median follow-up 72 months. Morbidity in 80% of patients. After standard stimulation, 4 new programmings and 3 pacemaker replaces by battery discharge were performed. In one tendon detachment surgical revision was needed. In a descriptive way, Wexner score and quality of life didn´t improve after surgery but did postoperative anal pressures. Group III: Fecal incontinence significantly improved after subchronic test stimulation. Five patients (62,5%) received a definitive implantation. With a mean follow-up of 24 months morbidity was minor and one device was explanted. In a descriptive way, fecal incontinence and Wexner scores decreased and quality of life and anal pressures increased after permanent implant. CONCLUSIONS: Artificial bowel sphincter implantation is a simple procedure with high morbidity and explants but significantly improves anal continente, quality of life and anal resting pressures. Dynamic graciloplasty is a complex procedure with high morbidity. In a descriptive way, it increases anal pressures but didn´t improve neither fecal incontinence nor quality of life. Sacral neuromodulation is a simple procedure with minor morbidity. During subchronic stimulation a significant improvement in anal continence occurs that is maintained with permanent stimulation but the small sample in this phase didn´t allow obtaining definitive conclusions. The three analyzed techniques are useful alternatives for treatment of severe fecal incontinence, but in our experience the functional result with dynamic graciloplasty is worse.
This document abstract is also available in Spanish.
Bibliographical Information:

Advisor:Lledó Matoses, Salvador; Roig Vila, Jose Vte.; Alós Company, R.

School:Universitat de València

School Location:Spain

Source Type:Master's Thesis



Date of Publication:12/02/2005

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