The Editors welcome topical correspondence from readers relating to articles published in the Journal. Responses can be sent electronically via the BJS website (www.bjs.co.uk) or by post. All letters will be reviewed and, if approved, appear on the website. A selection of these will be edited and published in the Journal. Letters must be no more than 250 words in length. Letters submitted by post should be typed on A4-sized paper in double spacing and should be accompanied by a disk.
Complications and functional outcome following artificial anal sphincter implantation (Br J Surg 2002; 89: 877-881)
Sir
We commend the authors for their objectivity. Infection, migration and erosion are well-documented serious complications of artificial anal sphincter implantation, yet may be relatively under-reported. It has long been our belief that any artificial devices or material brought into direct contact and completely encircling the bowel wall would eventually fail as a result of displacement and/or subsequent erosion. In this long-term study over three-quarters of the patients experienced postoperative complications and nearly a third had to have definitive explantation of the device. Similar complications led to the failure and subsequent abandonment of the Angelchik prosthesis for gastro-oesophageal reflux disease 1 . In the light of the evidence in this study, we feel that the electrically stimulated gracilis neoanal sphincter perhaps offers a more suitable alternative than the artificial bowel sphincter for the treatment of severe end-stage faecal incontinence, since it utilises autologous tissue 2 . Whilst it appears a more complex procedure, with advances in technology and appropriate training it can now be performed with greater consistency and lower morbidity than during its initial development. Results from our centre show a significant decrease in sepsis and mechanical failure and an overall success rate of approximately 70 per cent in the longer-term. This improvement has been considerably aided by developing a supra-regionally funded multidisciplinary team with reasonable throughput. Whilst we reserve judgement on the artificial bowel sphincter, we suspect that with longer follow-up, like the Angelchik prosthesis, it will be confined to the annals of surgical history.