Total anorectal reconstruction with the artificial bowel sphincter: report of eight cases. A quality-of-life assessment.

Purpose: The artificial bowel sphincter has been proposed to treat patients with fecal incontinence. The good results achieved with this procedure encouraged us to use this device for reconversion of patients who previously underwent an abdominoperineal resection.

Methods: Between 1999 and 2001, we selected eight patients for the total anorectal reconstruction, five for a synchronous reconstruction, and three cases for a delayed procedure. One patient was male and seven were female. The mean age was 52.6 years. All the patients underwent a postoperative manometry and defecography. Continence and quality of life scores were also evaluated in the follow-up.

Results: The follow-up length ranged from 6 to 28 months. Manometry assessed a basal pressure with the ABS cuff inflated between 58 and 62.2 mmHg. All but one patient achieved a good grade of continence with a Wexner score range between 3 and 9. A certain degree of impaired evacuation occurred in three patients, but with adequate training this improved and did not affect patient's satisfaction. The administered questionnaires demonstrated a significant improvement in quality of life scores for stoma patients and an elevated quality of life in patients synchronously treated with artificial bowel sphincter implant.

Conclusion: The artificial bowel sphincter is a good option for reconstruction of patients previously treated with an abdominoperineal resection. The procedure is feasible and safe, without serious postoperative complications. The quality of life is improved when the procedure is performed in stabilized stoma patients and is acceptable for motivated patients synchronously implanted. As compared with electrostimulated graciloplasty, the artificial bowel sphincter technique seems to be easier to perform and more acceptable for the patients, although the cost of the device is still high.