MODERN SURGICAL-TREATMENT OF ANAL INCONTINENCE

New surgical treatment modalities have been developed for patients wit h anal incontinence resulting from extensive sphincter destruction and in whom standard sphincter repair has failed. These new modalities in clude the transposition of striated skeletal muscles combined with imp lantation of neurostimulators, artificial sphincters based on the same principle as artificial urinary sphincters, and direct sacral nerve s timulation. In a few reported series muscle transposition in combinati on with neurostimulation has given a satisfactory continence in 50-70% of the patients. The same is true for the smaller series published on artificial anal sphincters, whereas the results of sacral nerve stimu lation have thus far been reported in only a few patients. The selecti on of patients and the performance of these procedures should be limit ed to few specialist centres.