Surgery for faecal incontinence in adults (Cochrane Review)

A substantive amendment to this systematic review was last made on 12 March 1999. Cochrane reviews are regularly checked and updated if necessary.

Background: Faecal incontinence is a debilitating problem with significant medical, social and economic implications. Treatment options include conservative, non-operative interventions (e.g. pelvic floor muscle training, biofeedback, drugs) and surgical procedures. Surgery is used in selected groups of people when the structural and functional defects in the pelvic floor muscles or the anal sphincter complex can be corrected mechanically.

Objectives: To assess the effects of established surgical techniques for the treatment of faecal incontinence in adults who do not have rectal prolapse. Our aim was firstly to compare surgical management with non-surgical management and secondly, to compare the various surgical techniques.

Search strategy: Electronic searches of the Cochrane Incontinence Group trials register (February 2003), the Cochrane Colorectal Cancer Group trials register (March 1999), the Cochrane Controlled Trials Register (Issue 2, 1999), EMBASE (January 1998 to January 1999), SIGLE (January 1980 to December 1996), BIOSIS (January 1998 to March 1999), Science Citation Index (January 1998 to March 1999), Index to Scientific and Technical Proceedings (January 1982 to March 1999) were undertaken. The British Journal of Surgery (January 1995 to December 1998) and the Diseases of the Colon and Rectum (January 1995 to December 1998) were specifically hand searched. The proceedings of the Association of Coloproctology meeting held in 1999 were perused. Reference lists of all relevant articles were searched for further trials. Date of the most recent searches: February 2003.

Selection criteria: All randomised or quasi-randomised trials of surgery in the management of adult faecal incontinence (other than surgery for rectal prolapse).

Data collection and analysis: Two reviewers independently selected studies from the literature, assessed the methodological quality of eligible trials and extracted data. The three primary outcome measures were: change or deterioration in incontinence, failure to achieve full continence, and the presence of faecal urgency.

Main results: Four trials were included with a total sample size of 110 participants. All trials excluded women with anal sphincter defects detected by endoanal ultrasound examination. No trial included a group managed non-surgically. Two trials (56 participants) compared three approaches to pelvic floor repair (anterior levatorplasty, postanal repair and their combination total pelvic floor repair). One trial (30 participants) evaluated adding plication of the anal sphincter to total pelvic floor repair. The fourth trial (24 participants) compared a neosphincter procedure with total pelvic floor repair. No differences in the primary outcomes were detected, but data were few and inconsistently reported.

Reviewers' conclusions: The small number of relevant trials identified together with their small sample sizes and other methodological weaknesses severely limit the usefulness of this review for guiding practice. It was impossible to identify or refute clinically important differences between the alternative surgical procedures. Larger rigorous trials are needed.

Citation: Bachoo P, Brazzelli M, Grant A.. Surgery for faecal incontinence in adults (Cochrane Review). In: The Cochrane Library, Issue 3, 2003. Oxford: Update Software.

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This is an abstract of a regularly updated, systematic review prepared and maintained by the Cochrane Collaboration. The full text of the review is available in The Cochrane Library (ISSN 1464-780X).

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