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Systematic review of perianal implants in the treatment of faecal incontinence
British Journal of Surgery, 09/02/2011
Evidence Based Medicine
Hussain ZI et al. – This systematic review has identified variations in the practice of injection of bulking agents that appear to influence the likelihood of complications and affect the outcomes after treatment.
Methods- 39 publications were identified and studied.
- Following variables were pooled for univariable analysis: type, location, route of bulking agents, and the use of ultrasound guidance, antibiotics, laxatives and anaesthetics.
- Predictors of the development of complications and successful outcomes were identified by multivariable logistic regression analysis.
- Total of 1070 patients were included in the analysis.
- On multivariable analysis, the only significant predictor of the development of complications was the route of injection of bulking agents (odds ratio 3•40, 95 per cent confidence interval 1•62 to 7•12; P=0•001).
- 2 variables were significant predictors of a successful short–term outcome: the use of either PTQ (OR 5•93, 2•21 to 16•12; P=0•001) or Coaptite (OR 10•74, 1•73 to 65•31; P=0•001) was associated with a greater likelihood of success.
- Conversely, the use of local anaesthetic was associated with a lower likelihood of success (OR 0•18, 0•05 to 0•59; P=0•005).
- Failure to use laxatives in the postoperative period resulted in a poorer medium– to longer–term outcome (OR 0•13, 0•06 to 0•25; P=0•001).
