Presentation Authors: Michelle Van Kuiken*, Frank C. Lin, Victoria C.S. Scott, Nika Vinson, My-Linh Nguyen, Ja-Hong Kim, Shlomo Raz, Los Angeles, CA
Introduction: Fecal incontinence (FI) is a bothersome, lifestyle altering clinical problem to which there are limited treatment options of varying efficacy. We describe a new surgical technique utilizing autologous fascia lata (AFL) to provide external, circumferential coaptation to the anal sphincter to improve fecal continence.
Methods: The video demonstrates our technique for performing Autologous Fascia Lata Spiral Sling Anal Sphincter Reconstruction. A 1x12cm piece of AFL is harvested from the patient&[prime]s thigh using the Crawford fascial stripper. The patient is then repositioned into high lithotomy position. Four 2 cm incisions are made 2 cm from the anus at the 12, 3, 6, and 9 o&[prime]clock positions. We use a long clamp to transfer the graft from the posterior incision to the ischial fossa bilaterally and then to the anterior perineal transverse incision in a sequential manner. The sling forms circular ring around the rectum. With a finger in the rectum, we secure the AFL sling using 2-0 Vicryl sutures to fix the 2 ends of the sling material to provide adequate coaptation and tension. The ends of the sling are transferred to each lateral incision and sutured to the perianal tissue to prevent displacement. The wounds are irrigated and closed in 2 layers.
Results: We have performed this procedure on 19 patients (18 female, 1 male) with varying etiologies of FI since November 2016. Mean age at the time of surgery is 66 years with a median length of follow-up of 4 months. Eight of 19 patients had failed prior anal sphincteroplasty or plication procedures, 6/19 had failed or still had residual FI after Interstim, and one patient had failed a prior artificial anal sphincter. Since surgery, all patients have reported subjective improvement in their FI with about half of patients (10/19, 52.6%) reporting complete resolution of their FI. Fecal continence is greater with solid versus liquid stool. Complications have included constipation requiring manual disimpaction in 3 patients and wound dehiscence/infection in 2 patients. Long-term outcomes and quality of life data are pending.
Conclusions: AFL spiral sling anal sphincter reconstruction is a simple, minimally invasive procedure that utilizes the patient&[prime]s own tissue and can be performed in patients who have failed prior FI procedures. Initial outcomes demonstrate improved fecal control with minimal complications, however long-term data are lacking.