Gastroenterological options in faecal incontinence.

Faecal incontinence may be due to a trauma, a rectal prolapse, or a neurological disorder. Obstetric trauma: If the sphincter has been severed, direct repair is indicated. In the case of neurological damage, plication of the levators can provide significant improvement; while the post-anal repair has become popular, anterior sphincter plication and levatorplasty, provide equivalent results. Rectal prolapse: Full thickness rectal prolapse is frequently associated with incontinence. Two categories of operations have been described: local operative procedures (Delorme's plicature, perineal resection) provide poor results in term of restoration of continence and should be reserved to unfit and elderly patients; abdominal operations combine an extensive rectal mobilisation and they differ by the type of fixation. The Ripstein operation (fixation to the promontory by an encircling sling of non absorbable mesh) has long been popular in the United States, but is followed by severe constipation. In the simple suture rectopexy, the rectum is fixed to the pelvic floor and the presacral fascia by non absorbable procedures. In the Ivalon sponge rectoprexy, a polyvinyl alcohol mesh in secured between the sacrum and the rectum, and provides a dense fibrous reaction. In the antero-posterior Marlex rectopexy, a sheet of Marlex mesh is fixed posteriorly to the rectum, and a sling is interposed anteriorly in order to support the anterior wall. In the resection rectopexy, a sigmoid resection in added to the rectal fixation in order to suppress the redundant sigmoid which is responsible for the constipation frequently following rectopexy. Results of abdominal rectopexy are satisfactory in terms of recurrence and restoration of continence.(ABSTRACT TRUNCATED AT 250 WORDS)