Invited Commentary

  • Steven D. Wexner


Dr Pfeifer has clearly and expertly outlined the methods, techniques, results, and morbidity of sphincter repair and postanal repair in Chapter 28. Although the initial reported success rates with sphincter repair were in excess of 90%, several long-term studies have revealed those success rates are in the vicinity of 15% to 30% [1, 2, 3, 4]. There are certain factors that may be predictive of failure, including pudendal neuropathy. However, prior sphincter repair does not appear to auger for failure of subsequent sphincter repair [5]. Because of the unfortunately poor long-term efficacy of this operation, it is certainly not a panacea. Current debate centers around whether the anal sphincters should be repaired, as, although the procedure may improve incontinence, it may also induce significant scarring. If scarring is produced and the result is suboptimal, then subsequent procedures such as stimulated graciloplasty, artificial bowel sphincter, and even sacral nerve stimulation may not be as successful.


Fecal Incontinence Cleveland Clinic Sacral Nerve Stimulation Sphincter Defect Sphincter Repair 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Matsuoka H, Mavrantonis C, Wexner SD et al. Postanal repair for fecal incontinence — is it worthwhile? Dis Colon Rectum 2000;43:1561–1567.CrossRefPubMedGoogle Scholar
  2. 2.
    Halverson AL, Hull TL. Long-term outcome of overlapping anal sphincter repair. Dis Colon Rectum 2002;45:345–348.CrossRefPubMedGoogle Scholar
  3. 3.
    Bravo Gutierrez A, Madoff RD, Lowry AC et al. Long-term results of anterior sphincteroplasty. Dis Colon Rectum 2004;47:727–731; discussion 731–732.CrossRefPubMedGoogle Scholar
  4. 4.
    Zorcolo L, Covotta L, Bartolo DC. Outcome of anterior sphincter repair for obstetric injury: comparison of early and late results. Dis Colon Rectum 2005;48:524–531.CrossRefPubMedGoogle Scholar
  5. 5.
    Oberwalder M, Dinnewitzer A, Baig MK et al. Do internal anal sphincter defects decrease the success rate of anal sphincter repair? Tech Coloproctol 2006;10:94–97; discussion 97.CrossRefPubMedGoogle Scholar
  6. 6.
    Chan MK, Tjandra JJ. Sacral nerve stimulation for fecal incontinence. Dis Colon Rectum 2008;51:1015–1025.CrossRefPubMedGoogle Scholar
  7. 7.
    Shafik A. Perianal injection of autologous fat for treatment of sphincteric incontinence. Dis Colon Rectum 1995;38:583–587.CrossRefPubMedGoogle Scholar
  8. 8.
    Bernardi C, Favetta U, Peascatori M. Autologous fat injection for treatment of fecal incontinence: manometric and echographic assessment. Plast Reconstr Surg 1998; 102:1626–1628.CrossRefPubMedGoogle Scholar
  9. 9.
    Shafik A. Polytetrafluoroethylene injection for the treatment of partial fecal incontinence. Int Surg 1993;78:159–161.PubMedGoogle Scholar
  10. 10.
    Tjandra JJ, Lim JF, Hiscock R et al. Injectable silicone biomaterial for fecal incontinence caused by internal anal sphincter dysfunction is effective. Dis Colon Rectum 2004;47: 2138–2146.CrossRefPubMedGoogle Scholar
  11. 11.
    Altomare DF, La Torre F, Rinaldi M et al. Carbon-coated microbeads anal injection in outpatient treatment of minor fecal incontinence. Dis Colon Rectum 2008;51:432–435.CrossRefPubMedGoogle Scholar
  12. 12.
    Ganio E, Marino F, Giani I et al. Injectable synthetic calcium hydroxylapatite ceramic microspheres (Coaptite) for passive fecal incontinence. Tech Coloproctol 2008;12:99–102.CrossRefPubMedGoogle Scholar
  13. 13.
    Siproudhis L, Morcet J, Laine F. Elastomer implants in faecal incontinence: a blind, randomized placebo-controlled study. Aliment Pharmacol Ther 2007;25:1125–1132.CrossRefPubMedGoogle Scholar
  14. 14.
    Stojkovic SG, Lim M, Burke D et al. Intra-anal collagen injection for the treatment of faecal incontinence. Br J Surg 2006;93:1514–1518.CrossRefPubMedGoogle Scholar
  15. 15.
    Weiss EG, Efron JE, Nogueras JJ. Submucosal injection of carbon coated beads is a successful and safe office based treatment for fecal incontinence. Dis Colon Rectum 2002;45:a46–47.Google Scholar
  16. 16.
    Jorge JM, Wexner SD. Etiology and management of fecal incontinence. Dis Colon Rectum 1993;36:77–97.CrossRefPubMedGoogle Scholar
  17. 17.
    Efron JE, Corman ML, Fleshman J et al. Safety and effectiveness of temperature-controlled radio-frequency energy delivery to the anal canal (Secca procedure) for the treatment of fecal incontinence. Dis Colon Rectum 2003;46:1606–1616; discussion 1616–1618.CrossRefPubMedGoogle Scholar
  18. 18.
    Takahashi T, Garcia-Osogobio S, Valdovinos MA et al. Radio-frequency energy delivery to the anal canal for the treatment of fecal incontinence. Dis Colon Rectum 2002;45:915–922.CrossRefPubMedGoogle Scholar
  19. 19.
    Takahashi T, Garcia-Osogobio S, Valdovinos MA et al. Extended two-year results of radio-frequency energy delivery for the treatment of fecal incontinence (the Secca procedure). Dis Colon Rectum 2003;46:711–715.CrossRefPubMedGoogle Scholar
  20. 20.
    Shawki S, Wexner SD. Newer concepts in fecal incontinence: injectables and sacral nerve stimulation. Semin Colon Rectal Surg 2010;1:30–36.CrossRefGoogle Scholar
  21. 21.
    Wexner SD, Jin HY, Weiss EG et al. Factors associated with failure of the artificial bowel sphincter: a study of over 50 cases from Cleveland Clinic Florida. Dis Colon Rectum 2009;52:1550–1557.PubMedGoogle Scholar
  22. 22.
    Wexner SD, Coller JA, Devroede G et al. Sacral nerve stimulation for fecal incontinence: results of a 120-patient prospective multicenter study. Ann Surg 2010;251:441–449.CrossRefPubMedGoogle Scholar
  23. 23.
    Wexner SD, Hull T, Edden Y et al. Infection rates in a large investigational trial of sacral nerve stimulation for fecal incontinence. JOGS; pub online March 31, 2010.Google Scholar
  24. 24.
    Edden Y, Wexner SD. Therapeutic devices for fecal incontinence: dynamic graciloplasty, artificial bowel sphincter and sacral nerve stimulation. Expert Rev Med Devices 2009;6:307–312.CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Italia 2010

Authors and Affiliations

  • Steven D. Wexner
    • 1
  1. 1.Division of Colon and Rectal SurgeryCleveland Clinic FloridaWestonUSA

Personalised recommendations