CLINICAL, PHYSIOLOGICAL, AND RADIOLOGICAL STUDY OF A NEW PURPOSE-DESIGNED ARTIFICIAL BOWEL SPHINCTER

Background Studies of the use of artificial urinary sphincters for fae cal incontinence have led to refinement and adaptation of such sphinct ers to the anatomy of the anal region. We aimed to test this new devic e. Methods Six women, median age 53 (range 32-58) years, who were unsu itable for sphincter repair, had an artificial bowel sphincter implant ed as a one-stage procedure without colostomy cover. Clinical assessme nt, physiological testing, and endosonography were done before and aft er the operation. Plain radiography, three-dimensional endosonography, and magnetic-resonance imaging were done after the operation, to defi ne its anatomical location. Results Median follow-up was 10 (range 5-1 3) months and the device was functional in five patients. In one patie nt, the device was removed after ulceration through the skin, Of the p atients with intact devices, Wexner incontinence scores improved from a median of 19 (18-20) of 20 before the operation, to 3 (0-6) of 20 af ter the operation, Median anal pressure at rest significantly increase d from 60 (range 30-80) cm H2O to 110 (100-120) cm H2O, Functional ana l-canal length varied after the operation from 3.3 cm to 3.8 cm. There was no significant change in the maximum tolerated volume of the rect um (140 [80-230] vs 100 [75-250] mt), or rectal compliance (2.9 [2.8-6 .0] cm H2O/mL vs 3.5 [2.3-7.3] cm H2O/mL). All the imaging techniques accurately located the implant relative to the anal canal and pelvic f loor in each patient. Interpretation The new artificial bowel sphincte r provided a good functional result in five of the six patients, the s urgical procedure was straightforward, and the maximum resting anal pr essure rose without affecting rectal function. The ease of visualisati on of such implants in situ should aid simple management of complicati ons, should they arise.