The SECCA procedure for faecal incontinence: a review M. Frascio*, F. Mandolfino*, M. Imperatore*, C. Stabilini*, R. Fornaro*, E. Gianetta* and S. D. Wexner† *Patologia Chirurgica ad Indirizzo Gastroenterologico, DISC-Department of Surgical Sciences and Integrated Methodologies, School of Medical and Pharmaceutical Sciences,University of Genova, Genova, Italy and †Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, Florida, USA Received 24 January 2013; accepted 3 August 2013; Accepted Article online 27 August 2013 Abstract Aim The SECCA system is a treatment option for patients with faecal incontinence and was introduced into clinical practice in 2002. Clinical studies of radio- frequency energy to treat patients with faecal inconti- nence have been published. This article aimed to review all published series to assess the results of this treat- ment. Method Twelve studies were included. Outcomes anal- ysed included quality of life, the Wexner incontinence score, anorectal manometry and endoanal ultrasound findings. Results A total of 220 patients from 10 studies were included. In the majority of clinical studies, the SECCA procedure has been shown to be an effective treatment of mild-to-moderate faecal incontinence. Conclusion When patient selection is appropriate, this treatment has demonstrated clinically significant improvements in symptoms, as demonstrated by statisti- cally significant reductions in the Wexner incontinence and quality of life scores. Keywords Faecal incontinence, Wexner incontinence score, quality of life score, radiofrequency, SECCA procedure Introduction Faecal incontinence (FI) is defined as recurrent and uncontrolled passage of solid or liquid stool persisting for at least 1 month. Although not life threatening, it can seriously adversely affect quality of life (QoL) and frequently results in disability. Its incidence has been reported, in community-based studies, to range from 2% to 17%. It occurs more frequently among the elderly and in women [1]. In particular, a recent Niel- sen-conducted household survey study has shown that nearly 20% of mature American women suffer from troublesome leakage of stool [2]. Treatment normally depends on the specific cause of the FI, and various modalities are used, including medical treatment, bio- feedback and surgery. Patients with FI are generally initially managed with noninvasive low-risk treatments, including diet modification, antimotility agents, pelvic floor exercises, biofeedback or controlled evacuation [3,4]. However, there are no randomized controlled trials available and there are no internationally and universally accepted guidelines for the treatment of FI. The SECCA procedure, which involves the adminis- tration of temperature-controlled radiofrequency (RF) energy to the anal canal, was first used for the treatment of FI in Mexico in 1999. The predicate RF procedure, Stretta, revealed a therapeutic effect in the treatment of gastroesophageal reflux [5]. In 2002, the Food and Drug Administration (FDA) of the USA approved the SECCA system for use specifically in the treatment of patients with FI to solid or liquid stool occurring at least once per week, and who already had failed more conservative therapies. The therapeutic effect of the procedure has been related to the improvement of sphincter function and restored anorectal sensitivity. Various modes of action have been proposed, including an improvement in ano- rectal sensation and coordination through C and A delta afferent fibre neuromodulation, collagen and smooth-muscle remodelling and a modulation of inter- stitial Cajal cell function. RF also induces fibrosis and this may help continence [6]. The current review has been conducted to analyse the safety and efficacy of the SECCA procedure for the treatment of FI. Correspondence to: Marco Frascio MD, Patologia Chirurgica ad Indirizzo Gastroenterologico, DISC-Department of Surgical Sciences and Integrated Methodologies, School of Medical and Pharmaceutical Sciences, University of Genoa, Largo Rossana Benzi 8, 16132 Genova, Italy. E-mail: kalasks@ccf.org Colorectal Disease ª 2013 The Association of Coloproctology of Great Britain and Ireland. 16, 167–172 167 Narrative review doi:10.1111/codi.12403