ARTIFICIAL ANAL-SPHINCTER

PURPOSE: This study was undertaken to evaluate the use of a fully impl anted artificial anal sphincter for management of severe fecal inconti nence. METHODS: An artificial anal sphincter was implanted in 12 patie nts who failed conventional management for severe fecal incontinence. Careful patient followup was recorded during a mean 58-month follow-up . Patients underwent preoperative and postoperative manometric assessm ent. Functional and patient satisfaction evaluations were obtained by mailed questionnaire. RESULTS: Three infections and three mechanical c omplications occurred in four patients (33 percent). A successful outc ome was achieved in nine patients (75 percent). Postoperative manometr ic studies documented establishment of an elevated high-pressure zone compared with preoperative resting pressures. Seven patients returned a detailed functional assessment and patient satisfaction questionnair e at a mean of 40 months postsphincter activation. ALL seven patients reported continence to solid stool. Two patients had some problems wit h control of liquid stool, and three had occasional incontinence to fl atus. Six of the seven patients rated their bowel control as good to e xcellent. ALL seven respondents were satisfied with their functional i mprovement. CONCLUSIONS: Early experience with an artificial anal sphi ncter has demonstrated that continence can be restored with acceptable morbidity in patients with severe fecal incontinence.