A study of the efficacy of porcine dermal collagen (Permacol) injection for passive
fecal incontinence in the Colorectal Unit (CRU) at the Wits Donald Gordon Medical
Centre (WDGMC).
N Harran -Colorectal Fellow (WDGMC), J Herold, B Bebington, D Lutrin.
Introduction:
Between 1 and10% of adults are affected with fecal incontinence (FI). FI can result from
different mechanisms. We are reviewing patients who have sphincter intact FI.
There are currently limited treatment options available for this pathology. Conservative
methods which include dietary modifications, constipating agents and biofeedback are used
with limited benefit.
Permacol injection is the only alternative surgical option available to these patients, other
than a permanent stoma,. The international literature has shown a good outcome in patients
who are correctly selected. There is currently no South African data available on the long
term efficacy of this procedure.
Research Question:
The aim of this study is determine objectively if our patients with sphincter intact FI or
passive FI have an improvement in their symptoms post Permacol injection and if so, for
how long does the effect last.
Methods and Materials:
In phase I, patients who had the procedure between the 1st of January 2012 and the 31st of
December 2013 were assessed retrospectively. They were asked to complete a selfadministered Wexner and FI QoL score based on their symptoms pre operatively and a
second self-administered Wexner and FI QoL score post operatively. These results were
then analysed to assess the outcome of the procedure and determine the degree of benefit,
if any.
In phase II, patients will be enrolled prospectively. Recruitment commenced on the 1st of
April 2014 and will be close on the 31st of December 2015. Patients will be asked to
complete self-administered Wexner and FI QoL scores pre operatively and at intervals of 1,
3, 6, 12, and 18 months, to assess degree and duration of response.
Both phase I and phase II have been approved by the Wits HREC.
Conclusion:
The results from phase I will be available for presentation. Phase II data and results will only
be available in 2016. As there have been no local studies to assess the efficacy of Permacol
it will be interesting to see if our findings are of a similar nature to those described in the few
international trials on this procedure.