A systematic review of the clinical treatment of patients with fecal incontinence by artificial anal sphincter

Abstract BACKGROUND: This study aimed to evaluate and compare the safety and efficacy of artificial anal sphincters in clinical practice. Methods: A systematic review of articles in PubMed, MEDLINE, EMBASE, Web of Science, and the Cochrane Library was performed. The literature was reviewed three times by several independent investigators, resulting in the identification of 53 studies that met the criteria. The primary outcomes of interest included: adverse events, incontinence assessment, quality of life assessment, and anorectal manometry. RESULTS: A total of 12 postoperative complications related to the implantation of the different artificial anal sphincters were reported. Seven different incontinence rating scales and four quality of life scales were used to assess patients' fecal incontinence and improvement in quality of life. A total of 29 studies measured changes in patients' anorectal pressure before and after surgery. CONCLUSIONS: In terms of safety, the GK, SK, and MAS are simpler devices that cause less damage during implantation and have additional advantages over the AMS800, AN, PAS, and AAB. In terms of therapeutic efficacy, the AN, which is currently the most widely used, is technologically mature and has the best results, while the other artificial anal sphincters have also shown significant improvement in fecal incontinence.