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STIMULATED GRACILIS NEOSPHINCTER: A NEW PROCEDURE FOR ANAL INCONTINENCE
Author(s) -
Kennedy M. L.,
Nguyen H.,
Lubowski D. Z.,
King D. W.
Publication year - 1996
Publication title -
australian and new zealand journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.111
H-Index - 51
eISSN - 1445-2197
pISSN - 0004-8682
DOI - 10.1111/j.1445-2197.1996.tb01209.x
Subject(s) - medicine , fecal incontinence , anal canal , rectum , surgery , urology
Background: The gracilis muscle has been used previously to construct an anal neosphincter, but this was not successful since a short‐lived muscle contraction was insufficient to restore continence. Recently, a procedure was described in which conversion to a fatigue‐resistant muscle was achieved by chronic low frequency electrical stimulation, and the resultant ability to sustain a constant contraction was associated with improved continence. Our initial results with this procedure, using a standardized operation and treatment protocol in 12 consecutive patients. is reported. Methods: Seven women (mean age 50 years, range 22–71 years) had faecal incontinence, and five patients (F:M. 3:2; aged 53–72 years) underwent reconstruction after abdominoperineal excision of the rectum for cancer. A detailed questionnaire including continence score was completed pre‐operatively. Eight patients have been assessed after ileostomy closure at a mean time of 10 months. Results: Slow‐twitch muscle conversion was achieved in each case and all patients have a functional neosphincter. Mean continence score was 6.8 (range 4–12), and seven patients were continent. There was significant improvement in continence in the non‐cancer group ( p = 0.03). Mean pre‐operative resting anal pressure, functional neosphincter pressure (NPfunc), and maximal neosphincter pressure (NPmax) were 36, 102 and 207 cmH 2 O, respectively. There was a significant improvement in pressure comparing NPfunc ( P = 0.03) and NPmax ( P = 0.03) with pre‐operative pressure. Complications included deep vein thrombosis. pulmonary embolism, saphenous nerve injury, leg wound haematoma, and late pacemaker infection. Conclusion: The stimulated gracilis neosphincter achieves satisfactory continence in a majority of patients.