Factors Associated with Failure of the Artificial Bowel Sphincter: A Study of Over 50 Cases from Cleveland Clinic Florida

• Published in: Diseases of the colon & rectum Vol. 52; no. 9; pp. 1550 - 1557
• Main Authors: Wexner, Steven D, Jin, Hei Ying, Weiss, Eric G, Nogueras, Juan J, Li, Vicky Ka Ming
• Format: Journal Article
• Language: English
• Published: Hagerstown, MDc The ASCRS 01-09-2009; Lippincott Williams & Wilkins
• Subjects: Adult; Aged; Anal Canal - surgery; Biological and medical sciences; Cohort Studies; Defecation; Fecal Incontinence - therapy; Female; Florida; Gastroenterology. Liver. Pancreas. Abdomen; Humans; Male; Medical sciences; Middle Aged; Prosthesis Failure; Prosthesis Implantation; Prosthesis-Related Infections - etiology; Recovery of Function; Retrospective Studies; Risk Factors; Young Adult; Florida; United States; North America; America; Artificial sphincter; Prognosis; Artificial bowel sphincter; Complications; Gastroenterology; Complication; Epidemiology; Failure; Morbidity
• ISSN: 0012-3706; 1530-0358
• DOI: 10.1007/DCR.0b013e3181af62f8

PURPOSE:This study investigated the risk factors related to artificial bowel sphincter infection, complications, and failure.
METHOD:Complications may occur at any time after artificial bowel sphincter implantation. Early-stage complication is defined as any complications that occurred before artificial bowel sphincter activation, whereas late-stage complications are defined as any complications that occurred after device activation. Assessment of the outcomes of all artificial bowel sphincter operations included evaluation of factors related to patient demographics, operative procedures, and postoperative events.
RESULT:From January 1998 to May 2007, 51 artificial bowel sphincter implantations were performed in 47 patients (43; 84.3% female) with a mean age of 48.8 ± 12.5 (range, 19–79) years and a mean incontinence score of 18 ± 1.4 (range, 0–20). In 24 patients (54.5%), the etiology of incontinence was secondary to imperforate anus; 15 (24.2%) patients had obstetric injury or anorectal trauma. Twenty-three (41.2%) artificial bowel sphincter implantations became infected, 18 (35.3%) of which developed early-stage infection, whereas 5 (5.9%) had late-stage infection. One patient in the latter group had associated erosion, and two patient had fistula formation. Late-stage complications continued to increase with time. Multivariate analysis revealed that the time between artificial bowel sphincter implantation and first bowel movement and a history of perineal sepsis were independent risk factors for early-stage artificial bowel sphincter infection.
CONCLUSION:The time from implantation to first bowel movement and history of perineal infection were risk factors for early-stage artificial bowel sphincter infection and failure. Late-stage failures were more often the result of device malfunction and indicated the need for mechanical refinement.