SNFGE SNFGE
 
Thématique :
- Colo-proctologie
- Intestin/Nutrition/Troubles fonctionnels
Originalité :
Intermédiaire
Solidité :
Intermédiaire
Doit faire évoluer notre pratique :
Pas encore
 
 
Nom du veilleur :
Docteur Henri DAMON
Coup de coeur :
 
 
Diseases of the Colon & Rectum
  2017/01  
 
  2017 Jan;60(1):87-95.  
  DOI: 10.1097/DCR.0000000000000709  
 
  Long-term Experience of Magnetic Anal Sphincter Augmentation in Patients With Fecal Incontinence  
 
  Sugrue J, Lehur PA, Madoff RD, McNevin S, Buntzen S, Laurberg S, Mellgren A  
  https://www.ncbi.nlm.nih.gov/pubmed/27926562  
 
 

Abstract

BACKGROUND:

Magnetic anal sphincter augmentation is a novel technique for the treatment of patients with fecal incontinence.

OBJECTIVE:

The current study reports the long-term effectiveness and safety of this new treatment modality.

DESIGN:

This was a prospective multicenter pilot study.

SETTINGS:

The study was performed at 4 clinical sites in Europe and the United States.

PATIENTS:

The cohort included patients with severe fecal incontinence for ≥6 months who had previously failed conservative therapy and were implanted with a magnetic anal sphincter device between 2008 and 2011.

MAIN OUTCOME MEASURES:

Adverse events, symptom severity, quality of life, and bowel diary data were collected.

RESULTS:

A total of 35 patients (34 women) underwent magnetic anal sphincter augmentation. The median length of follow-up was 5.0 years (range, 0-5.6 years), with 23 patients completing assessment at 5 years. Eight patients underwent a subsequent operation (7 device explantations) because of device failure or complications, 7 of which occurred in the first year. Therapeutic success rates, with patients who underwent device explantation or stoma creation counted as treatment failures, were 63% at year 1, 66% at year 3 and 53% at year 5. In patients who retained their device, the number of incontinent episodes per week and Cleveland Clinic incontinence scores significantly decreased from baseline, and there were significant improvements in all 4 scales of the Fecal Incontinence Quality of Life instrument. There were 30 adverse events reported in 20 patients, most commonly defecatory dysfunction (20%), pain (14%), erosion (11%), and infection (11%).

LIMITATIONS:

This study does not allow for comparison between surgical treatments and involves a limited number of patients.

CONCLUSIONS:

Magnetic anal sphincter augmentation provided excellent outcomes in patients who retained a functioning device at long-term follow-up. Protocols to reduce early complications will be important to improve overall results.

 
 
Question posée
 
Quelles sont l’efficacité et la tolérance à long terme du sphincter anal magnétique (SAM) chez les patients présentant une incontinence fécale (IF)?
 
Question posée
 
Chez les patients qui gardent un SAM fonctionnel à long terme ce travail confirme l’efficacité clinique du SAM.
 
Commentaires

Cette étude multicentrique est intéressante car c'est la première rapportant les résultats à long terme de cette technique. Sa tolérance doit être évaluée ( sur 35 patients, 7 explantations du SAM, 1 stomie). Le SAM est un système prometteur, néanmoins sa place précise, dans l’algorithme de prise en charge de l’IF sévère, doit être précisée.

 
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