Bortolotti M. Problems with repairing gut sphincters malfunctions. World J Gastrointest Surg 2024; 16(8): 2396-2408 [PMID: 39220086 DOI: 10.4240/wjgs.v16.i8.2396]
Corresponding Author of This Article
Mauro Bortolotti, MD, Former Contract Professor, Department of Internal Medicine and Gastroenterology, S Orsola-Malpighi Polyclinic, University of Bologna, Via Massarenti 48, Bologna 40138, Italy. bormau@tin.it
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Frontier
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Surg. Aug 27, 2024; 16(8): 2396-2408 Published online Aug 27, 2024. doi: 10.4240/wjgs.v16.i8.2396
Problems with repairing gut sphincters malfunctions
Mauro Bortolotti
Mauro Bortolotti, Department of Internal Medicine and Gastroenterology, S Orsola-Malpighi Polyclinic, University of Bologna, Bologna 40138, Italy
Author contributions: Bortolotti M wrote and revised this manuscript.
Conflict-of-interest statement: The author reports no relevant conflicts of interest for this article. Prof. Mauro Bortolotti now is not longer part of the Department of Internal Medicine and Gastroenterology, S Orsola-Malpighi Polyclinic, University of Bologna
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Mauro Bortolotti, MD, Former Contract Professor, Department of Internal Medicine and Gastroenterology, S Orsola-Malpighi Polyclinic, University of Bologna, Via Massarenti 48, Bologna 40138, Italy. bormau@tin.it
Received: April 27, 2024 Revised: June 24, 2024 Accepted: July 15, 2024 Published online: August 27, 2024 Processing time: 111 Days and 7.5 Hours
Abstract
Correcting a gut sphincter malfunction is a difficult problem. Because each sphincter has two opposite functions, that of closure and opening, repairing one there is a risk of damaging the other. Indeed, widening a narrow sphincter, such as lower esophageal sphincter (LES) and anal sphincter, may cause gastroesophageal reflux and fecal incontinence, respectively, whereas narrowing a wide sphincter, may cause a difficult transit. All the corrective treatments for difficult or retrograde transit concerning LES and anal sphincter with their unwanted consequences have been analyzed and discussed. To overcome the drawbacks of sphincter surgical repairs, researchers have devised devices capable of closing and opening the gut lumen, named artificial sphincters (ASs). Their function is based on various mechanisms, e.g., hydraulic, magnetic, mechanical etc, operating through many complicated components, such as plastic cuffs, balloons, micropumps, micromotors, connecting tubes and wires, electromechanical clamps, rechargeable batteries, magnetic devices, elastic bands, etc. Unfortunately, these structures may facilitate the onset of infections and induce a local fibrotic reaction, which may cause device malfunctioning, whereas the compression of the gut wall to occlude the lumen may give rise to ischemia with erosions and other lesions. Some ASs are already being used in clinical practice, despite their considerable limits, while others are still at the research stage. In view of the adverse events of the ASs mentioned above, we considered applying bioengineering methods to analyze and resolve biomechanical and biological interaction problems with the aim to conceive and build efficient and safe biomimetic ASs.
Core Tip: Gut sphincter corrections are a difficult problem because each sphincter has two opposite functions, that of closure and opening; in repairing one, there is a risk of damaging the other, as demonstrated by the analysis of the literature on interventions for difficult transit concerning the lower esophageal sphincter and anal sphincter, as well as for gastroesophageal reflux and fecal incontinence. Furthermore, artificial sphincters (ASs) capable of closing and opening with various mechanisms, such as hydraulic, magnetic, etc, have suffered many complications, limiting their use in practice. Hence, it would be desirable to use computational bioengineering methods to create an efficient and safe AS.