Current management of fecal incontinence: Choosing amongst treatment options to optimize outcomes

Table 1 Success of biofeedback for fecal incontinence

Ref.	Year	Patients (n)	Significant reduction in incontinence (percentage of patients)	Improvement in quality of life (percentage of patients)	Adjuncts to traditional biofeedback
Keck et al[33]	1994	15	73%	NR	None
Solomon et al[28]	2003	102	70%	69%	Anal manometry, transanal ultrasound
Terra et al[34]	2006	239	60%	NR	EMG, electrostimulation
Naimy et al[30]	2007	49	None	None	Electrostimulation
Byrne et al[32]	2007	385	70%	87%	None
Heymen et al[27]	2009	45	76%	NR	None
Schwandner et al[29]	2010	158	50%	NR	EMG, electrostimulation
Bartlett et al[26]	2011	72	86%	100%	None
Jodorkovsky et al[31]	2013	12	80%	NR	None

NR: Not reported; EMG: Electromyography.

Table 2 Success of overlapping sphincteroplasty

Ref.	Year	No. of patients with follow-up	Mean follow-up (mo)	Success1 (percentage of patients)
Karoui et al[52]	2000	74	40	28%
Halverson et al[40]	2002	49	69	46%
Bravo Gutierrez et al[39]	2004	130	120	41%
Barisic et al[49]	2006	65	80	48%
Maslekar et al[55]	2007	64	84	80%
Oom et al[50]	2009	120	111	60%
Mevik et al[51]	2009	25	84	53%
Zutshi et al[53]	2009	31	129	0%

¹Success variably defined in studies. Good, excellent or complete continence included as success.

Table 3 Studies of outcomes of sacral nerve stimulation

Ref.	Year	Patients (n)	Significant reduction in incontinence scores and incontinent episodes	Significant increase in quality of life
Leroi et al[73]	2005	27	Y	Y
Boyle et al[63]	2009	15	Y	NR
Brouwer et al[64]	2010	55	Y	Y
Wexner et al[79]	2010	120	Y	Y
Hollingshead et al[76]	2011	18	Y	NR
Lim et al[78]	2011	41	Y	Y
Mellgren et al[81]	2011	83	Y	Y
George et al[77]	2012	23	Y	Y
Devroede et al[83]	2012	78	Y	Y
Hull et al[75]	2013	76	Y	Y
Damon et al[82]	2013	92	Y	Y

Y: Yes; NR: Not reported.

Table 4 Outcomes of artificial bowel sphincter

Ref.	Year	Patients (n)	Explanted devices (n)	Success (percentage of patients), intention to treat	Complications
Lehur et al[93]	2000	24	7	83%	Obstructed defecation
Altomare et al[94]	2001	28	3	75%	Obstructed defecation, infection, device erosion
Devesa et al[95]	2002	53	10	65%	Perforation, infection, sepsis, device erosion, pain, impaction
Wong et al[97]	2002	112	41	53%	Infection, pain
Lehur et al[101]	2002	16	4	69%	Erosion
Parker et al[96]	2003	45	18	49%	Infection, pain
O’Brien et al[98]	2004	14	1	NR as percentage	Obstructed defecation, non-healing of wound
Melenhorst et al[103]	2008	33	7	NR as percentage	Pain, perforation, infection, obstructed defecation
Ruiz Carmona et al[99]	2009	17	11	53%	Infection, erosion
Wexner et al[90]	2009	51	31	NR as percentage	Infection, malfunction, erosion, pain
Wong et al[100]	2011	52	14	67%	Perforation, cuff leak

NR: Not reported.

Table 5 Outcomes of graciloplasty

Ref.	Year	Type of graciloplasty	Patients (n)	Success (percentage of patients)
Kumar et al[114]	1995	Unstimulated	9	100%
Eccersley et al[113]	1999	Unstimulated	8	100%
Madoff et al[109]	1999	Stimulated	128	66%
Wexner et al[110]	2002	Stimulated	115	62%
Bresler et al[112]	2002	Stimulated	24	79%
Rongen et al[111]	2003	Stimulated	200	72%
Thornton et al[117]	2004	Stimulated	38	73%
Hassan et al[107]	2010	Stimulated	31	71%

Table 6 Outcomes of antegrade continence enema in incontinent adults

Ref.	Year	Patients using antegrade continence enema on follow-up	Percentage of patients achieving continence	Complication rate
Gerharz et al[121]	1997	8	100%	44%
Teichman et al[120]	1998	7	86%	71%
Teichman et al[128]	2003	4	75%	67%
Lefevre et al[127]	2006	18	94%	33%
Poirier et al[126]	2007	14	78%	67%

Table 7 Outcomes of radiofrequency energy treatments

Ref.	Year	Patients (n)	Significant improvement in incontinence scores after treatment	Significant improvement in quality of life
Efron et al[143]	2003	50	Y	Y
Felt-Bersma et al[147]	2007	11	Y	NR
Takahashi-Monroy et al[142]	2008	19	Y	Y
Lefebure et al[144]	2008	15	Y	N
Kim et al[148]	2009	8	N	N
Ruiz et al[145]	2010	24	Y	Y
Abbas et al[146]	2012	27	Y	NR

Y: Yes; N: No; NR: Not reported.

Table 8 Outcomes of dextranomer in hyaluronic acid gel for fecal incontinence

Ref.	Year	Patients (n)	> 50% reduction in fecal incontinence episodes (percentage of patients)	Significant quality of life improvement
Dodi et al[150]	2010	115	64%	Yes
Graf et al[161]	2011	136	52%	Yes
Schwandner et al[159]	2011	21	56%	Yes
Danielson et al[160]	2012	34	76%	Yes
La Torre et al[156]	2013	83	63%	Yes