Ventral Pelvio-anal Reconstruction as a Variation of established Surgical Management of Severe and Refractory Fecal Incontinence: A Case Series Study

Background: Conventional treatments may not be effective in some severe cases of fecal incontinence (FI). Objectives: In the present study, we evaluated the applicability of ventral pelvio-anal reconstruction (VPAR) as a modified operative technique for 17 patients with severe and refractory FI. Methods: We performed VPAR by placing a mesh in the perineum and securing it at the sacrospinal ligament on both sides. The Cleveland Clinic Incontinence Score (CCIS) and Fecal Incontinence Quality of Life (FIQoL) questionnaires were completed by the patients, and anorectal manometry was performed before and after the operation (3,6 and 12 months), and the results were compared against the baseline values. Results: The operation was successful in all patients; no mesh was explanted during the follow-up period, and all patients reported satisfactory outcomes. Postsurgical anorectal manometry showed an increase in both rest and squeeze pressures. The CCIS decreased while the FIQoL increased significantly during the first-year follow-up (P < 0.001). Conclusions: By incorporating the implant into the perineal body, we hypothesized that our combined technique would lead to favorable outcomes, and the preliminary results confirmed this. Further studies with larger patient populations and more extended follow-up periods are needed to confirm our satisfactory results and conclude that the VPAR approach is a safe and appropriate therapeutic option for patients with severe and refractory FI.