THD GateKeeper

Minimally invasive treatment for faecal incontinence

Faecal incontinence is the inability to control bowel movements, causing stool (feces) to leak unexpectedly from the anus. Also called bowel incontinence, faecal incontinence ranges from an occasional leakage of stool while passing gas to a complete loss of bowel control.

Features and benefits


THD® GateKeeper was devised with the aim to treat faecal incontinence by implanting specifi cally designed self-expandable prostheses into the intersphincteric space.

Solid agents in the inter-sphincteric space produce longer and stable results and ultrasound check in the long term reveals no migration of the prostheses in almost all cases.

Minimum discomfort, no major complications, no infection, minimum rate of implant extrusion (assuring patient compliance in observing bed rest or slowly moving out of bed to chair for 48 hours after the procedure to minimize early prosthesis dislocation).

Cases are tipically performed in 30 minutes or less.

This procedure is cost effective with low material expenditure combined with short hospital stays and limited pain medication.

Clinical studies

Gatekeeper Improves Voluntary Contractility in Patients With Faecal Incontinence
Ugo Grossi, MD , Veronica De Simone, MD, Angelo Parello, MD, Francesco Litta, MD, Lorenza Donisi, MD,
Gian Luca Di Tanna, PhD , Marta Goglia, MD, and Carlo Ratto, MD - 2018

Outcomes of Gatekeeper™ prosthesis implantation for the treatment of faecal incontinence: a multicenter observational study
Biondo S., Trenti L., Noguerales F., Nomdedeu J. et al - 2017

Multicentre observational study of the Gatekeeper™ for faecal incontinence
Ratto C., Buntzen S., Aigner F., Altomare D. F., Heydari A., Donisi L., Lundby L. and Parello A. - 2016

Treatment for Faecal Incontinence Results of sphincter augmentation with Hyexpan implants in a pilot study
Bouassida S., Krüger K., Adam U. - 2015

Simultaneous Delorme’s procedure and inter-sphinteric prosthetic implant for the treatment of rectal prolapse and faecal incontinence: Preliminary experience and literature review
Cavazzoni E., Rosati E., Zavagno V., Graziosi L. & Donini A. - 2015

Anal Gatekeeper a new bulking agent for faecal incontinence
Fabiani B., Menconi C.D.E., Giani I. & Naldini G. - 2014

Gatekeeper in faecal incontinence: prospective European multicentre study
Ratto C., Buntzen S., Ganio E., Altomare D.F., De La Portilla F. & Aigner F. - 2012

Novel bulking agent for faecal incontinence
Ratto C., Parello A., Donisi L., Litta F., De Simone V., Spazzafumo L. & Giordano P. - 2011