M T C Wong1, G Meurette, V Wyart, P-A Lehur. 1. Clinique de Chirurgie Digestive et Endocrinienne, Institut des Maladies de l'Appareil Digestif, University Hospital of Nantes, Nantes, France.
Abstract
AIM: The magnetic anal sphincter (MAS) is a recent surgical innovation for severe faecal incontinence (FI). With its place in the treatment algorithm of FI yet to be defined, we report a nonrandomized comparison between MAS and sacral nerve stimulation (SNS) in a single-centre cohort of patients with FI. METHOD: Data were reviewed from prospective databases. From December 2008 to December 2010, 12 women [median age 65 (42-76) years], having FI for a median of 6.5 years, were implanted with a MAS. Sixteen women, of similar age, preoperative function scores, aetiology and duration of incontinence, and implanted with a permanent SNS pulse generator during the same period, served as a reference group. The duration of hospital stay, complications, change in incontinence and quality of life scores and anal physiology were compared between the two groups. RESULTS: The duration of follow up was similar [MAS = 18 (8-30) months vs SNS = 22 (10-28) months; P = 0.318]. Four patients with MAS experienced a 30-day complication, and the device was removed from one patient in each group. A significant improvement in incontinence (P < 0.001) and quality-of-life scores (P < 0.04) occurred in both groups. Mean anal resting pressure increased significantly in patients implanted with a MAS (P = 0.027). CONCLUSION: In this single-centre nonrandomized cohort of FI patients, MAS was as effective as SNS in improving continence and quality of life, with similar morbidity. These results can now serve as a prelude to a randomized trial comparing the procedures.
AIM: The magnetic anal sphincter (MAS) is a recent surgical innovation for severe faecal incontinence (FI). With its place in the treatment algorithm of FI yet to be defined, we report a nonrandomized comparison between MAS and sacral nerve stimulation (SNS) in a single-centre cohort of patients with FI. METHOD: Data were reviewed from prospective databases. From December 2008 to December 2010, 12 women [median age 65 (42-76) years], having FI for a median of 6.5 years, were implanted with a MAS. Sixteen women, of similar age, preoperative function scores, aetiology and duration of incontinence, and implanted with a permanent SNS pulse generator during the same period, served as a reference group. The duration of hospital stay, complications, change in incontinence and quality of life scores and anal physiology were compared between the two groups. RESULTS: The duration of follow up was similar [MAS = 18 (8-30) months vs SNS = 22 (10-28) months; P = 0.318]. Four patients with MAS experienced a 30-day complication, and the device was removed from one patient in each group. A significant improvement in incontinence (P < 0.001) and quality-of-life scores (P < 0.04) occurred in both groups. Mean anal resting pressure increased significantly in patients implanted with a MAS (P = 0.027). CONCLUSION: In this single-centre nonrandomized cohort of FI patients, MAS was as effective as SNS in improving continence and quality of life, with similar morbidity. These results can now serve as a prelude to a randomized trial comparing the procedures.
Authors: Andreas M Kaiser; Guy R Orangio; Massarat Zutshi; Suraj Alva; Tracy L Hull; Peter W Marcello; David A Margolin; Janice F Rafferty; W Donald Buie; Steven D Wexner Journal: Surg Endosc Date: 2014-03-08 Impact factor: 4.584
Authors: William E Whitehead; Satish S C Rao; Ann Lowry; Deborah Nagle; Madhulika Varma; Khalil N Bitar; Adil E Bharucha; Frank A Hamilton Journal: Am J Gastroenterol Date: 2014-10-21 Impact factor: 10.864