Skip to main content

Advertisement

SpringerLink
Log in

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

  • Rapid Communication
  • Published:
International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

References

  1. Duelund-Jakobsen J, Worsoe J, Lundby L, Christensen P, Krogh K (2016) Management of patients with faecal incontinence. Therap Adv Gastroenterol 9:86–97. doi:10.1177/1756283X15614516

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Ditah I, Devaki P, Luma H, Ditah C, Njei B, Jaiyeoba C et al (2014) Prevalence, trends, and risk factors for fecal incontinence in United States adults, 2005–2010. Clin Gastroenterol Hepatol 2:636–643. doi:10.1016/j.cgh.2013.07.020

    Article  Google Scholar 

  3. Van Koughnett JA, Wexner SD (2013) Current management of fecal incontinence: choosing amongst treatment options to optimize outcomes. World J Gastroenterol 19:9216–9230. doi:10.3748/wjg.v19.i48.9216

    Article  PubMed  PubMed Central  Google Scholar 

  4. Kenefick NJ, Vaizey CJ, Malouf AJ, Norton CS, Marshall M, Kamm MA (2002) Injectable silicone biomaterial faecal incontinence due to internal anal sphincter dysfunction. Gut 51:225–228

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Al-Ozaibi L, Kazim Y, Hazim W, Al-Mazroui A, Al-Badri F (2014) The Gatekeeper™ for fecal incontinence: another trial and error. Int J Surg Case Rep 5:936–938. doi:10.1016/j.ijscr.2014.08.002

    Article  PubMed  PubMed Central  Google Scholar 

  6. Ratto C, Buntzen S, Aigner F, Altomare DF, Heydari A, Donisi L, Lundby L, Parello A (2016) Multicentre observational study of the Gatekeeper for faecal incontinence. Br J Surg 103:290–299. doi:10.1002/bjs.10050

    Article  CAS  PubMed  Google Scholar 

  7. Ratto C, Parello A, Donisi L, Litta F, De Simone V, Spazzafumo L, Giordano P (2011) Novel bulking agent for faecal incontinence. Br J Surg 98:1644–1652. doi:10.1002/bjs.7699

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Shafik A (1993) Polytetrafluoroethylene injection for the treatment of partial fecal incontinence. Int Surg 78:159–161

    CAS  PubMed  Google Scholar 

  9. Vaizey CJ, Kamm MA (2005) Injectable bulking agents for treating faecal incontinence. Br J Surg 92:521–527. doi:10.1002/bjs.4997

    Article  CAS  PubMed  Google Scholar 

  10. Rames RA, Aaronson IA (1991) Migration of polytef paste to the lung and brain following intravesical injection for the correction of reflux. Pediatr Surg Int 6:239–240

    Article  Google Scholar 

  11. de la Portilla F, De Marco F, Molero M, Sánchez-Hurtado MA, Pereira S (2015) Calcium alginate as a rectal bulking agent. Experimental pilot study to determine its migratory trend and locoregional reaction. Int J Color Dis 31:1251–1252. doi:10.1007/s00384-015-2451-z

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Coloproctology Unit. Clinical Management Unit of General and Gastrointestinal Surgery Division, Seville Biomedical Research Institute (IBIS). University Hospital Virgen del Rocío/CSIC/University of Seville, Avda Manuel Siurot s/n, 41013, Seville, Spain

    F de la Portilla, ML Reyes-Díaz, MV Maestre, RM Jiménez-Rodríguez, AM García-Cabrera, JM Vázquez-Monchul, JM Díaz-Pavón & FC Padillo-Ruiz

  2. Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD o Ciberehd), Instituto de Salud Carlos III, Madrid, Spain

    F de la Portilla

Authors
  1. F de la Portilla
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. ML Reyes-Díaz
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. MV Maestre
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. RM Jiménez-Rodríguez
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. AM García-Cabrera
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. JM Vázquez-Monchul
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. JM Díaz-Pavón
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. FC Padillo-Ruiz
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to F de la Portilla.

Ethics declarations

The study protocol was approved by the Ethics Committee of the Virgen del Rocío Hospital, and all patients gave written informed consent to participate.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

de la Portilla, F., Reyes-Díaz, M., Maestre, M. et al. Ultrasonographic evidence of Gatekeeper™ prosthesis migration in patients treated for faecal incontinence: a case series. Int J Colorectal Dis 32, 437–440 (2017). https://doi.org/10.1007/s00384-016-2742-z

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00384-016-2742-z

Keywords

Search

Navigation