摘要
Anal incontinence(AI)reflects the final common pathway of a multitude of aetiological factors and,as an underestimated clinical problem,it represents a major social and economic burden.Its epidemiology and objective assessment of the severity of the problem are discussed in this Special Edition by Nevler from Israel.In the 1980s,the management of AI included some form of sphincter repair or scaffold,as discussed by Pescatori and Pescatori,with the construction of a colostomy as the only other surgical option.The development of a series of complicated muscle transposition procedures ensued and was supplemented by electrical stimulation,following an improvement in our understanding of the basic functioning of the voluntary myocyte.These procedures are discussed by Barisˇic′and Krivokapic′.This approach was followed by the adoption,from urological practice,of an artificial bowel sphincter that could be used to augment a perineal colostomy,in some cases of total anorectal reconstruction,and in patients with complex congenital anomalies after failed reconstruction.Neither of these more complex approaches has effectively stood the test of time,resulting in high complication rates,and the frequent need for operative revision and ultimate explantation of the device.
