what are the risks of a bowl balloon operation?

Answer 1

Definition
The Artificial Bowel Sphincter, or ABS, is a device implanted under the skin which is designed to mimic the natural function of the anal sphincter.

Candidates
The ABS is designed for use when a sphincteroplasty has been tried and failed or when there is insufficient healthy muscle to perform a sphincteroplasty.

The ABS device has been in use since 1972 and was approved by the Food and Drug Administration (FDA) in 1999.
The device consists of three parts:

1. An inflatable cuff, placed in the anus
2. A balloon reservoir, placed in the pubic area
3. A pump, placed in the pubic area, connecting the cuff and balloon

Procedure

The ABS is implanted in the Operating Room. It may be inserted by a surgeon specializing in gynecology, general, or colo-rectal surgery.

Two incisions are made to implant the ABS device. The first incision is placed between the anus and the vagina or scrotum. This allows for the inflatable cuff to be inserted around the anal sphincter. The second incision is made in the pubic area. This allows for the insertion of the balloon behind the pubic bone. A small pocket is made under the skin of the labia or scrotum by using the two existing incisions. This is where the pump is placed.

Initially, fluid is placed in the balloon. After activation (6-8 weeks), fluid is transferred from the balloon to the cuff. This transfer of fluid inflates the cuff. Once inflated, the cuff is in its normal position, or ‘resting state’. The cuff places pressure on the anal canal allowing it to remain closed. This pressure prevents the accidental passage of stool.

When you feel the need to move your bowels, you will press the pump located in the labia or scrotum several times. Pressing the pump will move the fluid from the cuff to the balloon. This action releases the pressure on the anal canal. The anus will open and a spontaneous bowel movement will occur. The balloon will automatically deflate after several minutes, moving the fluid from the balloon back to the cuff. Once the cuff is inflated, the anal canal is closed preventing the passage of stool.

Infection

Great lengths are taken to prevent infection. Before surgery, the patient will have an extensive bowel preparation with oral antibiotics. IV antibiotics will be given prior to entering the operating room. In surgery, the rectum will be irrigated with Betadine, a solution that prevents the spread and growth of bacteria. A sponge in the rectum or ‘finger cot’ may be used to prevent stool spillage and allow for frequent rectal exams. Gentamycin, an antibiotic, is used to irrigate the incisions and to soak the ABS device.

A hospitalization stay of 2-3 days will allow monitoring for infection. A post-op diet of clear liquids for the first few days and the bowel preparation before surgery will assist in minimal passage of stool initially after the operation.

Infection is a major concern with the ABS device. Approximately 15% of patients may require removal of the device due to infection. Once the infection clears, a new device may be placed. Other complications that can occur after ABS placement include erosion, incontinence, pump migration, constipation, equipment failure, and outlet obstruction.


Erosion

Erosion, wearing away, of the surrounding tissues may occur, causing migration of the pump, balloon, or cuff. This typically happens in older adults whose tissues are more fragile. Balloon, cuff, or pump migration will require cuff replacement.

Incontinence

Continued incontinence may occur. This can be caused by a cuff leak, fluid leak, cuff looseness, cuff remaining open, or pump malfunctions. Treatment can be as simple as adding additional fluid, a cuff size change, cuff replacement, or pump replacement or repositioning. An unbuttoned cuff will require a smaller cuff size. Patients with poor rectal sensation may have continued problems with incontinence. In some cases, complete replacement or exploration may be required. Also, for the first 6-8 weeks following surgery, your ABS device will not be active. This means that you will experience some incontinence.


Constipation

If constipation occurs, it may be the result of the cuff being too tight, pump malfunction, or taking too many narcotics. Treatment could involve replacing the cuff size, replacing the pump, or eliminating narcotics. Special attention needs to be given to constipation post-op. The passage of hard stool can tear stitches out of fragile muscle. A short post-op hospital stay will help reduce this risk. To help decrease the risk of constipation, you should drink lots of fluids following the surgery.


Pump Migration

If pump migration occurs, repositioning or replacing the pump will usually resolve the problem. Pump revisions will occur on the opposite side of the pelvis.


Outlet Obstruction

Outlet obstruction is rare and occurs in the population with chronic nerve or muscle dysfunction such as Multiple Sclerosis. Outlet obstruction is caused by muscle dysfunction in the pelvic floor.

Post-Op

The effectiveness of the ABS device will in part be determined by the patient. Following dietary instructions to avoid constipation is imperative. A diet rich in fiber and/or fiber supplements, like Metamucil or Citrucel, and drinking plenty of water will assist in keeping the stool soft.

Nothing should be inserted into the anus for at least 6 weeks to avoid injury to the surgical area. Sexual intercourse, bicycle riding, intense physical exercise, heavy lifting, squatting, and bearing down should be avoided for 2-3 months.

Introduction:
Gastrointestinal (GI) complications following heart operation may be life-threatening. Systematic analysis of risk factors to allow early identification of patients at risk for GI complication may lead to the development of strategies to mitigate this complication as well as to optimize management after its occurrence.

Methods:
Of 8709 consecutive patients undergoing heart operation during 7 years (1997–2003), 46 (0.53%) developed GI complications requiring surgical consultation. Preoperative, intraoperative, and postoperative predictors of complication and death were identified and compared with a control group.

Results:
Significant (P < 0.05) preoperative predictors of complication were prior cerebrovascular accident (CVA), chronic obstructive pulmonary disease (COPD), type II heparin-induced thrombocytopenia, atrial fibrillation, prior myocardial infarction, renal insufficiency, hypertension, and need for intra-aortic balloon counter-pulsation. The most frequent serious GI complication was mesenteric ischemia, which developed in 31 (67%) patients. Twenty-two (71%) of these patients were explored, and 14 (64%) died within 2 days of heart operation. Of the 9 patients with mesenteric ischemia who were not explored, 7 (78%) died within 3 days of heart operation. Other complications included diverticulitis (5), pancreatitis (4), peptic ulcer disease (4), and cholecystitis (2). The mortality rate in this group of other diagnoses was lower (40%), and death occurred later (32 days) after heart operation (P = 0.03 compared with mesenteric ischemia). Predictors of death from GI complication included New York Heart Association (NYHA) class III and IV heart failure, smoking, chronic obstructive pulmonary disease, history of syncope, aspartate aminotransferase (AST) >600U/L, direct bilirubin >2.4mg/dL, pH < 7.30, and the need for >2 pressors.

Conclusions:
The most common catastrophic GI complication after cardiac surgery is mesenteric ischemia, which is frequently fatal. This complication may be a result of atheroembolization, heparin-induced thrombocytopenia, or hypoperfusion. Techniques to reduce the occurrence of and/or preemptively diagnosis postcardiotomy mesenteric ischemia are necessary to decrease its associated mortality.

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Abstract
PATIENTS AND METHODS
RESULTS
DISCUSSION
ACKNOWLEDGMENTS
REFERENCES



Gastrointestinal (GI) complications after heart operation are rare but carry significant morbidity and mortality even when recognized early and treated appropriately. Although several centers have reported retrospective reviews of GI complications after heart operation, few have undertaken systematic analyses of preoperative, intraoperative, and postoperative variables that contribute to this entity.1–18 Risk stratification based on identification of such variables may influence cardiac surgeons to alter their operative strategy or early postoperative management decisions. Identification of risk factors for GI complication should heighten the index of suspicion of the treating physician when confronted with a postoperative course, which deviates from the expected norm. Finally, identification of risk factors for death after GI complication provides general surgeons with clinically relevant features indicating subsets of patients most likely to benefit from and survive laparotomy. Such information would help to direct more rational utilization of resources and may provide a framework for providing patients and their families with realistic expectations should such complications occur. Accordingly, we reviewed the case records of 46 patients suffering GI complication from 8709 consecutive patients that underwent heart operation at the Massachusetts General Hospital (MGH), searching specifically for the influence of 89 variables cross-matched with the Society of Thoracic Surgery database on the odds of development of GI complication as well as on outcome after complication.

Answer 2

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Answer 3

I have never heard of that particular operation. Do you it named correctly?