A posterior anal sling for fecal incontinence: results of a 152-patient prospective multicenter study

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• 作者：Anders Mellgren ; MD^a ; Massarat Zutshi ; MD^b ; Vincent R. Lucente ; MD^c ; Patrick Culligan ; MD^d ; Dee E. Fenner ; MD^e ; ^{deef@med.umich.ed" class="auth_mail" title="E-mail the corresponding author} ; on behalf of the TOPAS Study GroupHueylan Chern ; Patrick Culligan ; Dee Fenner ; Brooke Gurland ; Mickey Karram ; Ann Lowry ; Vincent Lucente ; Jorge Marcet ; Catherine Matthews ; Anders Mellgren ; Miles Murphy ; Shane McNevin ; Mikio Nihira ; Bartley Pickron ; Reza Rahbar ; Sowsan Rasheid ; Brian Raybon ; Charbel Salamon ; Dana Sands ; Abbas Shobeiri ; MD ; Madhulika Varma ; Massarat Zutshi
• 刊名：American Journal of Obstetrics and Gynecology
• 出版年：2016
• 出版时间：March 2016
• 年：2016
• 卷：214
• 期：3
• 页码：349.e1-349.e8
• 全文大小：915 K

文摘

The transobturator posterior anal sling (TOPAS) system is a posterior anal sling that is a minimally invasive, self-fixating polypropylene mesh intended to treat fecal incontinence (FI) in women who have failed conservative therapy.

Objective

We are reporting 1-year outcome in a prospective, multicenter study under investigational device exemption, evaluating this new treatment modality.

Study Design

A total of 152 women were implanted with the TOPAS system at 14 centers in the United States. FI was assessed preoperatively and at the 12-month follow up with a 14-day bowel diary, Cleveland Clinic Incontinence Scores, and FI Quality of Life questionnaires. Treatment success was defined as reduction in number of FI episodes of ≥50% compared to baseline. Missing bowel diary data were considered treatment failures. The Wilcoxon signed rank test was used to compare changes observed at 12 months vs baseline.

Results

Mean age was 59.6 years old (SD 9.7). The mean duration of FI was 110 mo (range 8-712) months. Mean length of the implant procedure was 33.4 (SD 11.6) minutes. Mean EBL was 12.9 (SD 10.5) mL. Average follow-up was 24.9 months. At 12 months, 69.1% of patients met the criteria for treatment success, and 19% of subjects reported complete continence. FI episodes/wk decreased from a median of 9.0 (range 2-40) at baseline to 2.5 (range 0-40) (P < .001). FI days decreased from a median of 5.0 (range 1.5-7) at baseline to 2.0 (range 0-7) (P < .001) over a 7-day period. FI associated with urgency decreased from a median at baseline of 2.0 (range 0-26) to 0 (range 0-14.5) (P < .001). The mean Cleveland Clinic Incontinence Scores decreased from 13.9 at baseline to 9.6 at 12 months (P < .001). FI Quality of Life scores for all 4 domains improved significantly from baseline to 12 months (P < .001). A total of 66 subjects experienced 104 procedure- and/or device-related adverse events (AEs). Most AEs were short in duration and 97% were managed without therapy or with nonsurgical interventions. No treatment-related deaths, erosions, extrusions, or device revisions were reported. The most common AE categories were pelvic pain (n = 47) and infection (n = 26). Those subjects experiencing pelvic pain had a mean pain score (0-10 scale, 0 = no pain) during the 12-month follow-up of 1.2 (SD 2.4).

Conclusion

The TOPAS system provides significant improvements in FI symptoms and quality of life with an acceptable AE profile and may therefore be a viable minimally invasive treatment option for FI in women.