Artificial bowel sphincter: Long-term experience at a single institution

Susan C. Parker, Michael P. Spencer, Robert D. Madoff, Linda L. Jensen, W. Douglas Wong, David A. Rothenberger

Research output: Contribution to journalArticlepeer-review

80 Scopus citations

Abstract

PURPOSE: This study was undertaken to evaluate a single-institution experience with the Acticon® artificial bowel sphincter for the treatment of intractable fecal incontinence. METHODS: At the University of Minnesota, 45 consecutive patients underwent artificial bowel sphincter placement (Group I, 1989-1992, n = 10; Group II, 1997-2001, n = 35). Group I was reviewed retrospectively and Group II prospectively. RESULTS: The outcome for Group I patients was initially reported in 1995 (mean age, 32; range, 15-52 years; 7 males). Of these 10 patients, 4 required explantation (2 required stomas), and 6 have a functional artificial bowel sphincter; 2 patients had devices successfully replaced for fluid leaks (at 6 and 10 years). In Group II, artificial bowel sphincter placement was attempted in 37 patients and was successful in 35 (mean age, 47; range, 18-72 years; II males). A total of 14 patients required explantation, 12 (34 percent) for infection and 2 (6 percent) for pain. In total, 13 patients have required 21 revisions, including 7 complete device replacements. The infection rate for revisions was 19 percent; four patients required explantation after revisions. Of 18 patients whose artificial bowel sphincter failed, 9 required a stoma. In all, 17 (49 percent) patients have a functional artificial bowel sphincter. In Group II fecal incontinence severity scores decreased from a mean of 103 preimplant to 59 at one year and to 23 at two or more years (P < 0.001) in patients who retained their devices. Quality of life scores improved in all patients at six months and at one year (P < 0.01). CONCLUSION: Artificial bowel sphincter therapy leads to long-term improved continence and quality of life in patients whose implantation is successful. Success rates have not improved in the two patient groups, with infection remaining a major challenge. However, once successfully established, artificial bowel sphincter function remains stable for many years.

Original languageEnglish (US)
Pages (from-to)722-729
Number of pages8
JournalDiseases of the colon and rectum
Volume46
Issue number6
DOIs
StatePublished - Jun 1 2003

Keywords

  • Acticon Neosphincter
  • Artificial anal sphincter
  • Artificial bowel sphincter
  • Fecal incontinence
  • Quality of life

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