Artificial Bowel Sphincter

Augmentation of the sphincter with a prosthetic device was first reported for fecal incontinence in 1992 after the idea was borrowed from urology, where artificial sphincters are used for urinary incontinence.8 The current device used for fecal incontinence, the ActiconTM NeoSphincter (American Medical Systems, Minnetonka, MN), consists of three silas-tic components: an inflatable cuff, a pressure-regulating balloon, and a control pump that allows activation or deactivation of the device (Figure 6-10.4). The inflatable cuff is implanted around the anus and is connected by silastic tubing to the control pump placed in the scrotum of males or in the labium major of females. The control pump is also connected to the pressure-regulating balloon implanted in the space of Retzius. When activated, the cuff is distended and the anus is occluded. The pressure-regulating balloon maintains the cuff pressure. To defecate, the patient compresses the control pump several times, and the fluid is displaced out of the cuff and into the regulating balloon.

The artificial sphincter is placed with the patient under general anesthesia in the lithotomy position after having undergone a mechanical and antibiotic bowel preparation and rectal irrigation with Betadine solution. Attention is given to prevention of contact of the silastic components with lint and powder because these materials tend to easily adhere with potential for contribution to infection. Either through an anterior perineal incision or bilateral perianal incisions, blunt dissection is used to create the circumferential tunnel around the anal canal several centimeters deep in the ischiorectal fossa. The occlusive cuff is appropriately sized and placed with the connection tubing on the same side as the patent's dominant hand. A suprapubic incision is made and the pressure-regulating balloon placed in the space of Retzius. Blunt dissection creates a dependent pouch in the scrotum or labia into which the control pump is placed. The tubings are connected but the device is left deactivated for the first 6 weeks postoperatively.

Figure 6-10.4. Schematic of the Artificial Bowel Sphincter™ in male (a) and female (b).

The Acticon™ NeoSphincter received Food and Drug Administration (FDA) approval in 1999. A recent, multicenter, nonrandomized trial revealed the device to have a significant rate of clinical success (85%), enhancement in quality of life, and a high degree of safety.9 However, similar to the stimulated graciloplasty, limitations in the use of this technique are related to the high rate of complications, most of which are related to infections of the foreign material with subsequent need for surgical revision. Other complications are related to erosion of the components into adjacent structures or device malfunction with a device explant rate of 36%.9 The cost involved and the morbidity from this device and the stimulated graciloplasty are approximately the same. In a recent prospective comparison of eight cases of dynamic graciloplasty and eight implantations of the ABS followed over 3 years, there was no difference in complications, wound healing problems, or explantation rates, although the ABS was found to be more effective in lowering the fecal incontinence score.10 Nonetheless, this remains an important alternative for patients with end-stage fecal incontinence when no other surgical or medical options exist except stoma. At this point, long-term studies are still needed to determine the longevity of the device.

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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