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Functional Results and Quality of Life Following Magnetic Anal Sphincter Augmentation in Severely Incontinent Patients

Kim, Mia, MD*,†; Meurette, Guillaume, MD, PhD*; Ragu, Ramasamy, MD*,‡; Wyart, Vincent*; Lehur, Paul Antoine, MD, PhD*

doi: 10.1097/SLA.0000000000002512
ORIGINAL ARTICLES

Objective: Magnetic anal sphincter augmentation is a novel surgical option in the treatment of severe fecal incontinence. This study aimed to analyze functional results, quality of life, and satisfaction after implantation in the mid-term, and to identify factors associated with success of this new treatment.

Methods: All patients, who underwent magnetic anal sphincter augmentation procedure at a single center between December 2008 and January 2016, were consecutively included. Symptom severity [Cleveland Clinic Incontinence Score (CCIS)], quality of life [Fecal-Incontinence Quality of Life Questionnaire (FIQL)], bowel diary data, and patients’ satisfaction were assessed before and after implantation.

Results: Forty-five patients (43 female), mean (s.d.) age 66.82 (±10.07), were followed for a median of 36 months (range 6–84). Two patients were explanted and 1 lost to follow-up. On a 3-week diary, major leakage rate significantly improved as did CCIS and FIQL. No significant difference was seen for flatus and minor leaks. Postoperative decrease of CCIS by ≥5.5 points correlated best with satisfaction, expressed by 22 patients (48% in intention-to-treat analysis). An independent predictive factor for success after implantation was no previous fecal incontinence surgical treatment.

Conclusions: Satisfaction, functional, and quality of life outcomes improve significantly following magnetic anal sphincter augmentation.

*Clinique de Chirurgie Digestive et Endocrinienne, Institut des Maladies de l’Appareil Digestif, University Hospital of Nantes, Nantes, France

Department of General, Visceral, Vascular, and Paediatric Surgery, University Hospital of Wuerzburg, Wuerzburg, Germany

Department of Surgery, Hospital Selayang, Selangor, Malaysia.

Reprints: Prof. Paul Antoine Lehur, MD, PhD, Clinique de Chirurgie Digestive et Endocrinienne, Institut des Maladies de l’Appareil Digestif, University Hospital of Nantes, Nantes 44093, France. E-mail: paulantoine.lehur@chu-nantes.fr.

M.K. and G.M. contributed equally to this study.

Sources of Funding: Magnetic anal sphincter augmentation implantation was supported by the Innovation committee of the University Hospital of Nantes, France (Comedims) for the first implantations and with a grant from the Direction Générale de l’Offre de Soins (DGOS), French Ministry of Health for the following procedures. M.K. was recipient of an ESCP fellowship 2015 grant; P.A.L. and G.M. were supported by CEREC, Bureau des associations, CHU de Nantes, France. P.A.L. has a consulting agreement with Torax Medical Inc.

The authors report no conflicts of interest.

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