Introduction Faecal incontinence (FI) affects between 1–10% of adults in varying degrees. Current epidemiological studies have shown that up to 1% of adults have regular episodes of faecal incontinence that adversely impacts their quality of life. A variety of synthetic and biological agents have been used for both overlapping sphincter repair (OSR) and as an anal bulking agent. The aim of this review is to provide an overview of the use of biological materials in the augmentation of the sphincter repair.

Method A systematic search of PubMed was conducted using the search terms ‘anal bulking agents’, ‘anal sphincter repair’ or ‘overlapping sphincter repair’. Studies that utilised biological material for either sphincter repair or as a bulking agent were included. Overall, 5 studies were indentified for analysis after inclusion and exclusion criteria were applied.

Results There were 3 studies with 127 patients of which 122 underwent anal bulking with a biological agent. 105 patients received a cross-linked porcine dermal collagen in the form of PermacolTM and a further 17 received Glutaraldehyde cross-linked (GAX) collagen, a highly purified bovine dermal collagen. Anorectal physiology was carried out in 27 patients and demonstrated deterioration in maximum resting pressure, and no significant change in maximum squeeze increment.

Quality of life scores such as St Mark’s incontinence score, SF-36 and the Cleveland Clinic Florida Incontinence Score (CCFIS) demonstrated an improvement in scores at 6 weeks and 6 months, but this had deteriorated at 12 month follow up. There were no complications reported.

10 patients received a cross-linked porcine dermal collagen (PermacolTM) for OSR and 13 patients received porcine intestinal submucosa (Surgisis©) to carry out an anal encirclement procedure. Improvements in Faecal Incontinence Severity Index (FISI), CCFIS and two subscales of Faecal Incontinence Quality of Life (FIQL) (coping/behaviour and embarrassment) were observed in the group of patients undergoing OSR. Furthermore, the FISI, Wexner score and all components of FIQL score (lifestyle, coping/behaviour, depression and embarrassment) showed an improvement following anal encirclement using biological material. Incontinence episodes decreased to an average of one per week from 8 to 10 preoperatively and no complications were reported.

Conclusion Sphincter augmentation with biological material has demonstrated significantimprovement in continence and quality of life scores in the short term compared to traditional repair. Long-term studies are necessary to determine if this effect is sustained.

Disclosure of interest None Declared.