Problems with repairing gut sphincters malfunctions

Table 1 List of malfunctions of sphincters with their respective repairing interventions followed by positive results and negative consequences; The table proves the correctness of the statement that repairing one function of a sphincter , the other remains more or less damaged

Sphincter malfunction	Repair of sphincter malfunction	Function improvement1	Damage of the opposite function1
		Dysphagia	Gastro-esophageal reflux
LES achalasia	LHM[1,2]	++++	++++
	POEM[3]	++++	+++
	Pneumatic dilation[5]	+++	+++
	Botox[7]	++	++
	Nifedipine and isosorbide dinitrate	+++ (transitory)	/
		Transit improvement	Fecal incontinence
Anal sphincter opening impairment	Internal sphincterotomy[12]	++++	++/+++
	GTN and calcium channel antagonists (topical)[15]	++	+
	Botulinum toxin injection[16]	++	+
		Ger prevention	Dysphagia
Gastro-esophageal reflux	LNF[20]	++++	++++
	PF, by Toupet[21]	++++	+++
	AF by Dor[23]	++++	+++
	TIF[24] (Esophyx[26], MUSE[28,29], Plicator instrument[30], NDO Plicator[31], GERDx device[32] and Endocinch[33])	++	+/++
	Stretta® system[39]	++	+
	Mucosal resection[42,43]	+++	+++
	Mucosal ablation[44]	+++	+++
	Band ligation[45] and clip-band ligation[46]	+++	+++
		FI prevention	Transit impairment
Fecal incontinence	Anal sphincter encirclement with meshes[47,48]	+	+
	Infiltrations with bio-compatible materials[49]	+	+
	Sphinkeeper[50]	+++	+++
	Gracilis muscle transplant[51,52]	+++	+++

¹The level of improvement and that of damage vary from ++++ (high) to + (low). AF: Anterior fundoplication; Botox: Botulinum neurotoxin; FI: Fecal incontinence; GTN: Glyceryl trinitrate; LES: Lower esophageal sphincter; LHM: Laparoscopic Heller’s myotomy; LNF: Laparoscopic Nissen fundoplication; MUSE: Ultrasonic surgical endostapler Medigus; PF: Posterior fundoplication; POEM: Peroral esophageal myotomy; TIF: Endoscopic incisionless fundoplication.

Table 2 List of different operating modes utilized for the artificial sphincters with the indication of the sphincter to replace

Operative strategies for artificial sphincters function	Sphincter replaced
Hydraulic
ActiconTM neosphincter[54]	Anal sphincter
Prosthetic anal system[56,57]	Anal sphincter
Artificial anal band, alias soft anal band or AMI artificial anal sphincter[58]	Anal sphincter
German artificial sphincter system[59,60]	Anal sphincter
Magnetic
Magnetic collar LINX[62]	LES
Magnetic collar FENIX[63]	Anal sphincter
Two-plaques magnetic system[61]	LES
Two-plaques magnetic system	Anal sphincter
A mixed bag of strategies
Artificial anal sphincter using a shape memory alloy[80,81]	Anal sphincter
Puborectalis-like artificial anal sphincter[84]	Anal sphincter
Internal artificial anal sphincter[86]	Anal sphincter
Artificial anal sphincter based on a novel clamping mechanism[87]	Anal sphincter
Artificial anal sphincter system[88]	Anal sphincter

LES: Lower esophageal sphincter.