A systematic review of the clinical treatment of patients with fecal incontinence by artificial anal sphincter

Abstract

Background: This study aimed to evaluate and compare the safety and efficacy of artificial anal sphincters in clinical practice.

Methods: A systematic review of literatures on artificial anal sphincters in PubMed, MEDLINE, EMBASE, Web of Science, and the Cochrane Library was performed. The literature was reviewed three times by several independent investigators, resulting in the identification of 47 studies that met the inclusion criteria. The primary outcomes of interest included adverse events, incontinence assessment, quality of life assessment, and anorectal manometry.

Results: A total of 12 postoperative complications related to the implantation of the different artificial anal sphincters were reported. Four different incontinence rating scales and four quality of life scales were used to assess patients' fecal incontinence and improvement in quality of life. A total of 29 studies measured changes in patients' anorectal pressure before and after surgery.

Conclusions: In terms of safety, patients implanted with an artificial anal sphincter may develop complications such as pain, infection, defecation obstruction, and surgical revision. In terms of effectiveness, different artificial anal sphincters had significant effects on patients with fecal incontinence, but as a result of the insufficient sample size of the study, more relevant studies are needed for further validation in the future.

Keywords: Artificial anal sphincter; Clinical application; Fecal incontinence; Surgery; Systematic review.