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Issue 3:
  • In this issue a discussion of the following article concerning Artificial Anal Sphincter will take place:

    Title: Multicenter retrospective analysis of the outcome of artificial
    anal sphincter implantation for severe fecal incontinence.
    Authors: Altomare DF, Dodi G, La Torre F, Romano G, Melega E,
    Rinaldi M.
    Journal: BJS 2001; 88(11):1481-6.

    From the flow equation point of view the artificial anal sphincter works by maintaining adequate A.C. Length dictated by the diameter of the cuff diameter and minimizes the A.C. diameter by the inflation of the balloon.
    The presence of a pliable anal canal is essential for the action of the Artificial Anal Sphincter in order to reduce the A.C. diameter. The procedure should be accompanied by lysis of any fibrosis, which may cause tethering of the A.C. to the peri-anal structures.
    The Artificial sphincter tries to mimic the normal anal sphincter by its ability to relax in order to achieve normal unobstructed defecation on volition, using artificial inflatable anal sphincter replacement was followed by Anismus if the cuff diameter used is 2.9 cm as compared to cuff diameter of 2 cm in this study from Italy. This finding can be explained by the flow equation simply by the fact that the cuff diameter represents the minimal A.C. length which can be achieved during defecation. For example at any given anal canal diameter (e.g. 2 cm), using 2.9 cm cuff would lead to a 45% increase in A.C. resistance during defecation which needs a proportionate increase in IRP during defecation in order to maintain the same Flow Index achieved with 2 cm diameter cuff during defecation (more straining for the increasing resistance).
    The use of cuffs with 2.9 cm diameter should be abandoned and the inner diameter of the Artificial sphincters with 2c diameter cuffs should be tailored according to the mean intrarectal pressures during defecation measured preoperatively and accordingly the expected flow index postoperatively.
    (N.B. for the details of such calculations, please contact us on our e-mail




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