ACYST Secca Sacral Nerve Stimulation Artificial Bowel Sphincter and Stimulated Graciloplasty

Susan M. Cera and Eric G.Weiss

Patients with severe fecal incontinence unresponsive to conservative measures can be divided into two broad categories of surgical approach. The first group includes those patients with an identifiable anatomic sphincter defect who can expect a 70% to 80% surgical success rate with overlapping sphincteroplasty.1 The absence of pudendal neuropathy yields the best outcome in these patients.2 The second group includes those patients with extensive sphincter damage, muscle loss, or pudendal neuropathy not amenable to direct sphincter repair. Fortunately, because of the development of newer surgical techniques, the patient with severe fecal incontinence is not obligated to a permanent stoma.

In the first half of the century, patients who were not candidates for sphincter repair underwent sphincter reconstruction with muscle transpositions involving either the gluteus maximus or gracilis. These techniques only met with moderate success because the static, striated muscle flaps were prone to fatigue with chronic contraction. The transposed muscle did not have any involuntary tone at rest, and patients had to perform awkward movements to achieve imperfect continence.

In the 1980s, external stimulators were applied to the muscle transpositions to create dynamic neosphincters with resting muscle tone. The low-frequency electrical stimulation provided by these stimulators transforms the skeletal muscle from fast-twitch fatigue-prone (type II) muscle fibers to slow-twitch fatigue-resistant (type I) muscle fibers. However, the procedure involves many components and requires technical expertise predisposing to an array of complications that proved to undermine the advantages. Since its introduction in the 1990s, the Artificial Bowel SphincterTM (ABS) offers an alternative, safe, and convenient option in sphincter reconstruction. In addition, the development of other techniques, including injection of submucosal beads (ACYSTtm), radiofrequency (the Secca® procedure), and sacral nerve stimulation (SNS), serve to augment the native continence mechanism in those who do not require neosphincter construction.

Constipation Prescription

Constipation Prescription

Did you ever think feeling angry and irritable could be a symptom of constipation? A horrible fullness and pressing sharp pains against the bladders can’t help but affect your mood. Sometimes you just want everyone to leave you alone and sleep to escape the pain. It is virtually impossible to be constipated and keep a sunny disposition. Follow the steps in this guide to alleviate constipation and lead a happier healthy life.

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