Management of fecal incontinence - focus on a vaginal insert for bowel control Eric R Sokol Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA, USA Fecal incontinence, also referred to as accidental bowel leakage, is a debilitating condition that impacts quality of life in a significant number of women. Current treatments for fecal incontinence include behavioral modification, biofeedback, drug therapy, and invasive surgical procedures. However, these treatments have suboptimal efficacy due to patient adherence, variability of presentation across patients, cost, and additional health risks. A vaginal bowel control system (EclipseTM System) was developed to offer a low-risk, effective, and patient-managed approach to treating accidental bowel leakage. The vaginal bowel control system consists of a vaginal insert and user-controlled, pressure-regulated pump. Once inflated, the balloon of the vaginal insert is directed posteriorly to occlude the rectum, allowing the woman to immediately regain control of bowel function. This article will introduce the design evolution and feasibility studies of the Eclipse System. In addition, this review will discuss the results from a recent clinical trial that demonstrated the safety and efficacy of the vaginal bowel control system in managing fecal incontinence and other symptoms of bowel dysfunction. Keywords: accidental bowel leakage, fecal urgency, vaginal bowel control system, Eclipse System, bowel function

Background/Objectives: Endometriosis is a chronic inflammatory systemic disease that commonly affects bowel structures, including the appendix, where it may mimic or coexist with chronic appendicitis. Visual inspection alone often fails to detect appendiceal involvement, leading to underdiagnosis and suboptimal management. This study investigates the prevalence and histopathologic spectrum of appendiceal abnormalities in patients undergoing minimally invasive laparoscopic surgery for endometriosis and evaluates the safety and postoperative outcomes of selective appendectomy. Methods: We conducted a retrospective cohort study of 236 patients who underwent a selective appendectomy concurrent with laparoscopic surgery for endometriosis with and without robotic assistance from January 2024 to April 2025. Preoperative evaluation included clinical assessment, imaging, and risk stratification using the Nezhat Endometriosis Risk Advisor tool, with some patients referred after positive ReceptivaDx testing. Intraoperatively, the appendix was examined for endometriosis, adhesions, or obliteration, and abnormal findings warranted removal using a vascular stapler. Postoperative outcomes and histopathologic results were assessed over six months, with appendiceal involvement analyzed in relation to endometriosis stage. Results: Of 236 patients who underwent selective laparoscopic appendectomy during surgical treatment for endometriosis, abnormal appendiceal pathology was identified in 216 (91.53%) patients. Histopathology revealed appendiceal endometriosis in 34 patients (14.41%), adhesions in 140 (59.32%), fibrous obliteration in 82 (34.75%), inflammation in 20 (8.47%), and neuroendocrine tumors in 3 (1.27%), one of which was malignant. Endometriotic lesions of the appendix showed a significant association with advanced-stage (III–IV) disease (p = 0.05), while other pathologies were not stage-dependent. No intraoperative complications occurred, and postoperative outcomes were favorable, with only one readmission unrelated to the appendectomy. Conclusions: Selective appendectomy during laparoscopic surgery for endometriosis revealed a high prevalence (91.5%) of appendiceal pathology. Even without visible implants, the appendix may contribute to symptoms, underscoring the importance of thorough intraoperative evaluation. Selective appendectomy based on surgical findings may aid symptom relief, prevent missed diagnoses, and enhance comprehensive management of endometriosis, but these potential benefits must be weighed against the small risks of concurrent appendectomy.

Importance: Cervical preservation versus removal is commonly debated among urogynecologists performing sacrocolpopexy (SCP), the gold standard reconstructive procedure for prolapse. A randomized controlled trial is unlikely to ever be performed. Objective: The objective was to compare the cost-effectiveness of total (TLH) versus supracervical (SCH) hysterectomy at the time of SCP. Study Design: Markov microsimulation evaluated 5-year outcomes after SCP with TLH or SCH. Route-specific complications included bladder/ureteral injury, cuff dehiscence, port-site hernia, mesh exposure, prolapse recurrence with or without retreatment, and occult uterine cancer. Quality-adjusted life years (QALYs) incorporated recovery, prolapse recurrence, and cancer treatment states with an annual 3% discount rate. Probabilistic sensitivity analysis (PSA, n=10,000) assessed model uncertainty. Results: Median costs were SCP/TLH=$16,117.50, SCP/SCH=$16,078.00 (Δ=$39.50, 0.2%). Median effectiveness was 4.65 QALYs for both. PSA showed TLH was more effective in 15.8%, SCH in 17.3%, with equal effectiveness in 67.0%. Net monetary benefit (NMB) favored SCH by $39.50 (<0.01% of total NMB). Conclusions: While risks vary between TLH and SCH, rare and mostly balanced complications, similar costs, and high efficacy regardless of route explain why both approaches perform equally overall.