Surgical Treatment of Patients with Constipation and Fecal Incontinence

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Patients with constipation and fecal incontinence usually come to the attention of the surgeon when conservative measures have failed to alleviate sufficiently severe symptoms. Following detailed clinical and physiologic assessment, the surgeon should tailor the procedure to specific underlying physiologic abnormalities to restore function. This article describes the rationale, indications (including patient selection), results, and current position controversies of surgical procedures for constipation and fecal incontinence, dividing these into those regarded as historical, contemporary, or evolving. Reported surgical outcome data must be interpreted with caution because for most studies the evidence is of low quality, making comparison of different procedures problematic and emphasizing the need for better designed and conducted clinical trials.

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Summary

With the advent of anorectal physiologic investigations, a detailed understanding of the pathophysiologic mechanisms underlying constipation and FI is evolving. The results of tests of anorectal physiologic function help to suggest appropriate rather than empiric management, particularly when surgical intervention is contemplated. In those patients referred for surgical amelioration of their symptoms, the integration of the findings from clinical history, physical examination, and

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    Marc A. Gladman is supported by the Frances and Augustus Newman Foundation Research Fellowship of the Royal College of Surgeons of England. Charles H. Knowles is funded by the Higher Education Funding Council for England.

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