RECENT ADVANCES IN THE SURGICAL-TREATMENT OF FECAL INCONTINENCE

Background Improved imaging and refined technology have led to a numbe r of recent advances in the surgical treatment of faecal incontinence. Methods Original articles, identified using a computer database (Medl ine), and recently published abstracts of meetings were selected on th e basis of greatest clinical relevance; these were reviewed. Results U ltrasonographic characterization has led to improved therapeutic strat egies. Simple structural damage is readily identified and external sph incter repair results in a good outcome for a majority of patients. Fo r more complex structural damage, or for the newly recognized primary internal sphincter degeneration, alternative treatment strategies are emerging. The electrically stimulated gracilis neosphincter and the ar tificial bowel sphincter offer good results. The latter may be a more simple operation. For structurally intact but weak sphincters, sacral nerve stimulation is a promising therapy. Other therapies, such as ant egrade irrigation, may be helpful for patients with neurological disor ders. Conclusion Better imaging, refined classification and new operat ions are leading to improved surgical techniques for faecal incontinen ce.