Anal sphincter reconstruction for fecal incontinence: Techniques, outcomes, and future directions

Abstract

Fecal incontinence, a debilitating condition that significantly impairs quality of life, affects 2%-21% of adults worldwide. For patients whose structural defects are unresponsive to conservative therapies, sphincter reconstruction remains the primary treatment approach. Although traditional surgical techniques effectively restore anatomy in the short term, their long-term efficacy is constrained by progressive muscle atrophy and fibrotic scarring. In complex cases, alternative interventions, including dynamic gracilis or gluteus maximus transposition and artificial sphincter implantation, offer therapeutic options yet are associated with increased surgical risks and high complication rates. Emerging therapies such as regenerative medicine and neuromodulatory approaches have potential, although further rigorous clinical validation is needed to establish standardized protocols. Optimizing fecal incontinence management necessitates precise patient stratification, multidisciplinary collaboration, and the development of individualized treatment algorithms. Advancements in this field depend on large-scale clinical trials and comprehensive long-term outcome assessments to improve therapeutic efficacy and patient-centered care.

Keywords: Fecal incontinence; Sphincter reconstruction; Overlapping sphincteroplasty; Sacral nerve stimulation; Regenerative medicine

Core Tip: Anal sphincter reconstruction is essential for fecal incontinence with structural defects. Overlapping sphincteroplasty provides good short-term results for acute injuries, though long-term efficacy often declines. Dynamic muscle transposition or artificial sphincters offer options for complex cases, despite significant complication risks. Sacral nerve stimulation demonstrates excellent sustained efficacy for neuromuscular dysfunction. Combining sphincteroplasty with sacral nerve stimulation represents a promising strategy for mixed defects. Regenerative approaches show potential but require further validation. Optimizing outcomes hinges on precise patient selection, multidisciplinary collaboration, and robust clinical trials to establish long-term safety and efficacy of evolving techniques.