Name of the Procedure:

Sphincteroplasty, anal, for incontinence, adult; implantation artificial sphincter

Summary

Sphincteroplasty with artificial sphincter implantation is a surgical procedure to treat anal incontinence in adults. It involves placing an artificial device around the anal sphincter to improve its function and control.

Purpose

The procedure is designed to address anal incontinence, which is the inability to control bowel movements. The goal is to restore continence, giving the patient better control over defecation and improving quality of life.

Indications

• Persistent anal incontinence unresponsive to conservative treatments.
• Damage or weakening of the anal sphincter muscles due to childbirth, surgery, or injury.
• Patients who are physically and mentally capable of operating the artificial sphincter device.

Preparation

• Patients may be required to fast for 8-12 hours before the procedure.
• Avoid certain medications that could increase bleeding risk, as advised by the physician.
• Diagnostic tests such as anal manometry, endoanal ultrasound, or MRI may be performed to assess the sphincter's condition.

Procedure Description

1. The patient is given general or regional anesthesia.
2. A small incision is made near the anal area.
3. The artificial sphincter, which consists of a cuff, pump, and balloon reservoir, is implanted around the anal canal.
   • The cuff is positioned around the sphincter.
   • The pump is placed in the scrotum (for men) or labia (for women).
   • The balloon reservoir is implanted in the abdomen.
4. The system is tested and adjusted for proper functionality.
5. The incision is closed, and the area is bandaged.

Duration

The procedure typically takes about 1.5 to 2 hours.

Setting

This surgery is usually performed in a hospital or specialized surgical center.

Personnel

• Colorectal or general surgeon
• Anesthesiologist
• Surgical nurses
• Operating room technicians

Risks and Complications

• Infection at the surgical site
• Bleeding or hematoma formation
• Device malfunction or erosion
• Pain or discomfort at the site of implantation
• Need for additional surgeries or device adjustments

Benefits

• Improved ability to control bowel movements
• Enhanced quality of life and confidence
• Potential for long-term continence

Recovery

• Patients may need to stay in the hospital for a day or two for observation.
• Pain and discomfort are managed with prescribed medications.
• Gradual resumption of daily activities within a few days.
• Full recovery and adaptation to using the artificial sphincter may take several weeks.
• Follow-up appointments are crucial for monitoring and adjusting the device.

Alternatives

• Pelvic floor physical therapy
• Dietary and lifestyle changes
• Medications to solidify stool
• Other surgical options like sphincter repair or colostomy
  • Pros: May be less invasive or more appropriate for certain conditions.
  • Cons: May not provide the same level of continence control as the artificial sphincter.

Patient Experience

During the procedure, patients are under anesthesia and will not feel anything. Postoperatively, they might experience pain or discomfort at the incision sites, managed with pain relief medications. Adjusting to the artificial sphincter requires practice and follow-up care, but most patients notice significant improvement in continence relatively quickly.