Ultrasonographic evidence of Gatekeeper™ prosthesis migration in patients treated for faecal incontinence: a case series

Background Faecal incontinence (FI) is both a medical and social problem, with an underestimated incidence. For patients with internal anal sphincter damage, implantation of biomaterial in the anal canal is a recognised treatment option. One such material, Gatekeeper™, has previously shown promising...

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Bibliographic Details
Published in:International journal of colorectal disease 2017-03, Vol.32 (3), p.437-440
Main Authors: de la Portilla, F, Reyes-Díaz, ML, Maestre, MV, Jiménez-Rodríguez, RM, García-Cabrera, AM, Vázquez-Monchul, JM, Díaz-Pavón, JM, Padillo-Ruiz, FC
Format: Article
Language:English
Subjects:
Analysis
Biological products
Care and treatment
Fecal Incontinence - diagnostic imaging
Fecal Incontinence - surgery
Female
Gastroenterology
Health surveys
Hepatology
Humans
Implants, Artificial
Incontinence
Internal Medicine
Male
Manometry
Medicine
Medicine & Public Health
Middle Aged
Proctology
Prostheses and Implants
Prosthesis
Prosthesis Failure
Quality of Life
Rapid Communication
Surgery
Treatment Outcome
Ultrasonography
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Summary:Background Faecal incontinence (FI) is both a medical and social problem, with an underestimated incidence. For patients with internal anal sphincter damage, implantation of biomaterial in the anal canal is a recognised treatment option. One such material, Gatekeeper™, has previously shown promising short- and medium-term results without any major complications, including displacement. The main aim of the present study is to assess the degree to which displacement of Gatekeeper prostheses may occur and to determine whether this is associated with patient outcomes. Methods Seven patients (six females) with a mean age of 55.6 years [50.5–57.2] and a mean FI duration of 6 ± 2 years were prospectively enrolled in the study. Each subject was anaesthetised and underwent implantation of six prostheses in the intersphincteric region, guided by endoanal 3D ultrasound (3D-EAU). Follow-up was performed at post-interventional months 1, 3, and 12 (median 12 ± 4 months), during which data were obtained from a defaecation diary, Wexner scale assessment, anorectal manometry (ARM), 3D-EAU, and a health status and quality of life questionnaire (FIQL). Results At 3-month follow-up, 3D-EAU revealed displacement of 24/42 prostheses in 5/7 patients. Of these, 15 had migrated to the lower portion and 9 to the upper portion of the anal canal and rectum. Despite this migration, treatment was considered successful in 3/7 patients. In one patient, it was necessary to remove a prosthesis due to spontaneous extrusion. Conclusions We have shown that displacement of the Gatekeeper™ prosthesis occurs, but is not associated with poorer clinical outcomes.
ISSN:0179-1958
1432-1262
DOI:10.1007/s00384-016-2742-z