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What is the best option for failed sphincter repair?
MedLine Citation:
PMID:  24617736     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
AIM: The study aimed to evaluate the outcome of various procedures for patients following failed sphincteroplasty.
METHOD: Patients who underwent surgery for failed sphincteroplasty from 1/2000-6/2012 were identified. They were assessed using the fecal incontinence quality of life (FIQoL) scale and Cleveland Clinic Florida FI Score (CCFFIS).
RESULTS: 59 patients [97% females; median age 52 (25-81) years] were identified. They underwent a repeated sphincteroplasty (RS; n=33), artificial bowel sphincter (ABS; n=11) and sacral nerve stimulation (SNS; n=15). The median follow-up was 31 (3-138) months. The RS group had a significantly wider external sphincter defect and had undergone fewer previous sphincteroplasties. The most common complication was infection. The incidence of complications was significantly higher after ABS (73%) compared with RS (24%), and SNS (33%) (p=0.01). Seventeen (29%) patients required reoperation for complications or failure, with a lower rate in the RS group (p=0.004). There was no difference in the rates of device removal after ABS or SNS. Ten (17%) patients underwent further surgery or re-implantation of the device with no difference between the groups. At follow-up, five (45%) ABS and ten (67%) SNS patients retained a functioning device (p=0.4). The mean postoperative CCFFIS decreased from 17.5 to 11.5 in RS, 18.7 to 8.6 in ABS, and 17.6 to 9.1 in SNS groups (p≤0.02 for all). There were no differences in the improvement of CCFFIS or FIQoL scores between the groups.
CONCLUSION: RS, ABS and SNS are associated with similar improvements in continence after failed sphincteroplasty. Due to increased complications and reoperation with ABS and SNS, RS may be the first step in managing these patients. This article is protected by copyright. All rights reserved.
Authors:
Kwang Dae Hong; Giovanna da Silva; Steven D Wexner
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2013-12-13
Journal Detail:
Title:  Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland     Volume:  -     ISSN:  1463-1318     ISO Abbreviation:  Colorectal Dis     Publication Date:  2013 Dec 
Date Detail:
Created Date:  2014-3-12     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  100883611     Medline TA:  Colorectal Dis     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
This article is protected by copyright. All rights reserved.
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