Continence improving surgery is rarely indicated – considering the number of sufferers!
Birth traumatic damage (e.g. perineal tear) is usually treated primarily by the obstetrician. Secondary treatment is only successful in less than 50% of incontinent patients.
Sphincteroplasties are used only when sphincter reconstruction is not indicated or has failed:
- Grazilisplasty – reinforcement of the sphincter system by the M. grazilis (thigh muscle of the adductor group); this is passed circularly around the anal canal; an implanted pacemaker thereby leads to a tonic contraction; for defecation (bowel movement), this is switched off percutaneously (from Latin per “through'” and cutis “skin”; “through the (healthy) skin”)
- “Articial bowel sphincter” (ABS) – a plastic ring is placed around the anal canal (rectum) with an inflatable cuff (pump system) that can be filled from a fluid reservoir, thereby sealing the anal canal. A pump valve controls the filling of the plastic ring. It is implanted in the labia (labia) or scrotum (scrotum). Approximately 70% of patients benefit from this sphincter replacement.
Procedures for rectal prolapse
Rectal prolapse (rectal prolapse) is a common cause of fecal incontinence. In such cases, a minimally invasive, i.e., laparoscopic, abdominal resection rectopexy (synonyms: rectopexy, sigmoid resection) is performed. In this procedure, the rectum is fixed (attached) to the promontory/os sacrum (sacrum), and if necessary, a bowel resection (partial removal of the bowel) is also performed (not obligatory!). Approximately 60-90% of patients achieve satisfactory fecal constinence this way.
Interventions for sensory incontinence
Sensory fecal incontinence occurs when the sensitive perception of the mucosa of the anal canal is disturbed. This is the case, for example, with hemorrhoidal prolapse (anal prolapse). In this case, a single or multiple closed or partially closed (Park’s/Longo’s) hemorrhoid removal is performed.
Procedures for neurogenic fecal incontinence
Sacral nerve stimulation (SNS)represents a new therapeutic procedure. It represents an ideal indication for neurogenic incontinence; this procedure is unsuitable for muscular defects.
