Placement of artificial bowel sphincters in the management of faecal incontinence

CRD COMMENTARY: The main drawback of this review was the quality of the included studies. The authors commented that their most serious concern was the lack of control groups with which to make comparisons. They were also worried about selection bias, since there was no a priori participant selection criteria before enrolment in the individual studies. The authors stated the research question, although it was worded differently in two places in the review, and also stated some of the inclusion and exclusion criteria. The literature search was comprehensive although it was limited to English language publications. The quality of the included studies was classified using a hierarchy of evidence scheme, which revealed that the included studies were of insufficient quality to enable a valid determination of the effectiveness. Despite this, the validity of the included studies was not assessed, and this would have shown the difference between well- and badly-conducted case series. The authors did not report how the articles were selected, or who performed the selection and data extraction. The data extracted were reported in tables and discussed in the text of the review. The studies were only summed in the tables, and were not analysed further. The authors' conclusions appear to follow from the results, but should be viewed with caution because of limitations in the quality of the included studies and in the review process.