Artificial bowel sphincter in severe anal incontinence

Summary Objective The artificial anal sphincter has been suggested as an alternative in the treatment of severe anal incontinence when conventional surgical methods are not possible or have failed. Experience in this procedure is still limited and the results have not yet been sufficiently established. The aim of this study is to evaluate the efficacy of the ACTICON® (American Medical Systems, Minneapolis, MN) on patients operated upon in our Unit. Patients and method In this prospective study an ACTICON® sphincter was implanted in 10 patients (8 women) with an average age of 56 years and with an average period of severe anal incontinence of 151 months. The origin of incontinence was obstetric injury (n: 4), neuropathy (n: 3) and sphincteral injury from previous anal surgery (n: 3). The degree of continence was measured using the Fecal Incontinence Scoring System (FISS) and the pre‐ and postoperative anal manometric parameters at 6‐month intervals. The average follow‐up time for the efficacy of the implanted system was 29 months. Results A total of 6 patients[60%] displayed complications in the immediate postoperative period: subaponeurotic reimplantation of the connecting tubes was necessary after infection of the abdominal wound (n:1); superficial dehiscence of the perianal wound (n: 2), infection of the perianal wound (n: 1) and perianal haematoma (n: 2) that were resolved by conservative treatment. For 3 patients[30%] the system was explanted, definitively in one and in 2 of them reimplanted successfully. At the end of the follow‐up period, 9 patients[90%] still have an activated artificial sphincter. The score on the Fecal Incontinence System decreased significantly after the system was activated (P