DOI: http://dx.doi.org/10.18203/2349-2902.isj20174876

Use of gatekeeper in obese patients with fecal incontinence before bariatric surgery, is it improving the results?

Ahmed Abdel Monem Ibrahim

Abstract


Background: Fecal incontinence or bowel incontinence is a lack of defecation control with loss of bowel continent for gas, liquid, or solid content. Causes of incontinence are so different and might occur as apart of diarrhea or constipation. After following up patients with gastric bypass surgery for bariatric purpose we observe that most of them develop incontinence by different grades after bariatric surgery. Also, some of them complaining from soiling by different degrees before any operative procedure. Gatekeeper is a bulking agent recently introduced for treatment of fecal incontinence, implants of polyacrylonitrile (4-6) implants are inserted in inter-sphincteric space (Gatekeeper, THD) is used as a bulking agent to increase the volume in the inter-sphincteric space in cases of fecal incontinence follow-up was at 2, 4, 8 months. Aim is to evaluate efficacy of gatekeeper application in obese patient with fecal incontinence after bypass bariatric surgery.

Methods: Thirty obese patients (19 females) and (11 males) undergoing bariatric surgery at Alsalama Hospital Abu Dhabi from the period between July 2015 to July 2017, are classified into two groups (group I) 15 patients (9 females and 6 males) are subjected to gatekeeper before gastric bypass surgeries and (group II) 15 patients (10 females and 5 males) not subjected to the use of gatekeeper and both groups were followed at 2, 4 and 8 months postoperative.

Results: This randomized controlled study was conducted on 30 patients between July 2015 to July 2017 at Alsalama hospital Abu Dhabi. The use of gatekeeper in obese patients undergo bypass surgery is un effective technique to improve liquid stool incontinence.

Conclusions: The use of gatekeeper in obese patients with fecal incontinence before gastric bypass surgery has improved the incontinence postoperative signs and symptoms.


Keywords


Gatekeeper, Incontinence, Obesity

Full Text:

PDF

References


Richter HE, Matthews CA, Muir T, Takase-Sanchez MM, Hale DS, Van Drie D, et a. A vaginal bowel-control system for the treatment of fecal incontinence. Obstetrics Gynecol. 2015;125(3):540-7.

Wald A, Bharucha AE, Cosman BC, Whitehead WE. ACG clinical guideline: management of benign anorectal disorders. Am J Gastroenterol. 2014;109:1141-7.

Christiansen J. Modern surgical treatment of anal incontinence. Ann Med. 1998;30:273.

Robson KM, Lembo AJ. Fecal incontinence in adults: etiology and evaluation. Available at http://www.uptodate.com/contents/fecal-incontinence-in-adults-etiology-and-evaluation. Accessed Aug. 8, 2015.

National Digestive Diseases Information Clearinghouse. Available at https://www.niddk.nih.gov/health-information/digestive-diseases. Accessed August 8, 2015.

Feldman M. Fecal incontinence. In: Feldman M, Friedman LS, Brandt L, eds. Sleisenger and Fordtran's Gastrointestinal and Liver Disease: Pathophysiology, Diagnosis, and Management. 10th ed. Philadelphia, Pa.: Saunders Elsevier; 2016. http://www.clinicalkey.com. Accessed August 14, 2015.

Kaiser AM, Orangio GR, Zutshi M, Alva S, Hull TL, Marcello PW, et al. Current status: new technologies for the treatment of patients with fecal incontinence. Surgical Endoscopy. 2014;28(8):2277-301.

Pico MF (expert opinion). Mayo Clinic, Jacksonville, Ha. August 25,2015.

Keating JP, Stewart PJ, Eyers AA, Warner D, Bokey EL. Are special investigations of value in the management of patients with fecal incontinence?. Diseases Colon Rectum. 1997;40(8):896-901.

Jarrett ME, Mowatt G, Glazener CM, Fraser C, Nicholls RJ, Grant AM, et al. Systematic review of sacral nerve stimulation for fecal incontinence and constipation. Br J Surg. 2004;91:1559-69.

Schwartz DA, Wiersema MJ. Endorectal endoscopic ultrasound in the evaluation of fecal incontinence. Available at http://www.uptodate.com/contents/endorectal-endoscopic-ultrasound-in-the-evaluation-of-fecal-incontinence. Accessed August 8, 2015.

Rao SS, American college of gastroenterology practice parameters committee. diagnosis and management of fecal incontinence. American college of gastroenterology practice parameters committee. Am J Gastroenterol. 2004;99:1585.

Whitehead WE, Rao SS, Lowry A, Nagle D, Varma M, Bitar KN, et al. Treatment of fecal incontinence: State of the science summary for the National institute of diabetes and digestive and kidney diseases workshop. Am J Gastroenterol. 2015;110:138.

Bharucha AE, Dunivan G, Goode PS, Lukacz ES, Markland AD, Matthews CA, et al. Epidemiology, pathophysiology, and classification of fecal incontinence: State of the science summary for the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) Workshop. Am J Gastroenterol. 2015;110:127.