Table 4.
Therapeutic options for different clinical scenarios in different guidelines
| ICS | NICE | ASCRS | Italian | French | |
|---|---|---|---|---|---|
| First surgical treatment in a young patient with a recent obstetric 100° EAS lesion and FI | SNM | Sphincteroplasty (if full-length lesion, no atrophy, no denervation, and with good voluntary contraction) | SNM/Sphincteroplasty (not clear) | SNM/Sphincteroplasty (it is not clear) | Sphincteroplasty |
| SNM in the rest | |||||
| First surgical treatment in a young patient with a recent obstetric > 120° EAS lesion and FI | Sphincteroplasty | Idem as previous scenario | SNM/Sphincteroplasty (not clear) | Sphincteroplasty | Not mentioned |
| Young patient with a recent obstetric EAS 90° lesion without FI: subclinical sphincter defect | Not mentioned | Not mentioned | Not mentioned | Not mentioned | SNM better than sphincteroplasty |
| -First surgical treatment in a ≥ 50 y.o. woman with FI and old 100° EAS lesion | SNM | Probably SNM due to atrophy or absence of voluntary contraction |
SNM/Sphincteroplasty (not clear) |
SNM | SNM |
| First surgical treatment in the idiopathic FI without EAS lesion | SNM | SNM | SNM | SNM | SNM |
| Second step after conservative treatment failure in Congenital FI in an adult patient |
MACE (poor outcome) Colostomy preferred |
ABS | ABS | Not mentioned | Not mentioned |
| Management of neurological patients with FI after conservative treatment | TAI | TAI | ABS | TAI | TAI |
| MACE (If TAI failure) | SNM in certain neurologyc patients | MACE (if TAI failure) | |||
| In some selected patients: ABS, SNM, SARS | SNM if central or incomplete peripheral non-progressive neurological lesion | ||||
| Management of traumatic FI with > 180° and/or multiple sphincteric disruption | Vaginal reconstruction | SG | ABS | Gluteoplasty graciloplasty or ABS | Not mentioned |
| SG | |||||
| ABS | ABS (less recommended) | ||||
| SNM | |||||
| FI without EAS lesion but post-hemorrhoidectomy and/or with IAS lesion postanal surgery |
Bulking agents? (Not clearly stated in this clinical scenario but recommended when minimal defect remains) |
Not mentioned |
Bulking agents? (Not clearly stated in this clinical scenario but declared to possibly help decrease episodes of passive FI) |
Bulking agents? (Can be used in patients with damaged or degenerated IAS with very limited evidence) |
Not mentioned |
| Ultimate options after previous treatment failures: SNM, sphincter repair, bulking agents | ABS | SG | ABS | Gluteoplasty | PTNS |
| SG | ABS | Stoma (last option) | Graciloplasty | ABS | |
| Stoma (last option) | Stoma (last option) | ABS | Bulking agents | ||
| Stoma (last option) | Stoma (last option) |
ICS International Continence Society, NICE National Institute for Health and Care Excellence, ASCRS American Society of Colon and Rectal Surgeons, FI Fecal Incontinence, EAS External Anal Sphincter, SNM Sacral Neuromodulation, MACE Malone Antegrade Continence Enema, ABS Artificial Bowel Sphincter, TAI Transanal Irrigation, SARS Sacral Anterior Root Stimulation, SG Stimulated Graciloplasty, PTNS Posterior Tibial Nerve Stimulation