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Injectable and Implantable Agents: Current Evidence and Perspective

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Management of Fecal Incontinence

Abstract

Injection of bulking agents into the anal canal is considered a “minimally invasive” approach to treat fecal incontinence. Different materials are currently available. Bulking agents can be injected into the anal canal submucosa, intersphincteric or within the sphincter defect scar tissue; the route of injection has been transanal/transmucosal, transsphincteric or intersphincteric, at different levels of the anal canal, in two, three, four, or more locations. A few adverse events have been documented following the bulking agents injection. Very variable results have been reported in numerous studies; however, frequently they are inconsistent and, in the majority of reports, referred to a limited duration of follow-up.

More recently different materials have been introduced in clinical practice, GatekeeperTM and SphinKeeperTM; they are delivered by “implantation.” These implants are made of a unique material (HYEXPANTM), solid at the time of delivery, but, absorbing fluids, expanded within 48 h. They are soft with shape memory. Few are the published reports but show, up to now, consistent results in terms of safety of implant procedure, durability of effects, and positive effects in reducing the fecal incontinence episodes and improving patients’ quality of life.

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Authors and Affiliations

  1. Proctology Unit, University Hospital “A. Gemelli”, Catholic University, Largo A. Gemelli, 8, 00168, Rome, Italy

    Carlo Ratto, Angelo Parello, Lorenza Donisi & Francesco Litta

Authors
  1. Carlo Ratto
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  2. Angelo Parello
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  3. Lorenza Donisi
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  4. Francesco Litta
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Correspondence to Carlo Ratto .

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Editors and Affiliations

  1. Sapienza - University of Rome, Rome, Italy

    Massimo Mongardini

  2. Sapienza - University of Rome, Rome, Italy

    Manuel Giofrè

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Ratto, C., Parello, A., Donisi, L., Litta, F. (2016). Injectable and Implantable Agents: Current Evidence and Perspective. In: Mongardini, M., Giofrè, M. (eds) Management of Fecal Incontinence. Springer, Cham. https://doi.org/10.1007/978-3-319-32226-1_10

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  • DOI: https://doi.org/10.1007/978-3-319-32226-1_10

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-32224-7

  • Online ISBN: 978-3-319-32226-1

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