Skip Navigation LinksHome > February 2014 - Volume 57 - Issue 2 > Electrically Stimulated Gracilis Neosphincter for End-stage...
Diseases of the Colon & Rectum:
doi: 10.1097/DCR.0b013e3182a4b55f
Original Contributions: Anorectal Disease

Electrically Stimulated Gracilis Neosphincter for End-stage Fecal Incontinence: The Long-term Outcome

Boyle, Derek J. M.D., F.R.C.S.; Murphy, Jamie B.Chir., Ph.D.; Hotouras, Alexander M.Sc., M.R.C.S. (Engl.); Allison, Marion E. R.G.N., M.Sc.; Williams, Norman S. M.S., F.R.C.S.; Chan, Christopher L. Ph.D., F.R.C.S.

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Abstract

BACKGROUND: Electrically stimulated gracilis neosphincter is an established treatment for patients with end-stage fecal incontinence. Few data, however, describe its long-term efficacy.

OBJECTIVE: This study aimed to assess the long-term functional outcome associated with this procedure.

DESIGN: Patients who underwent gracilis neosphincter construction between1989 and 2001 were identified from a prospectively recorded database. Demographics and pretreatment anorectal physiologic data were available for all patients.

SETTINGS: This study was conducted at an academic colorectal unit in a tertiary center.

PATIENTS: Sixty patients (median age, 42 years; 46 females) with fecal incontinence and a Williams continence score ≥5 were recruited to the study. The causes of incontinence included obstetric injury (n = 22), anal surgery (n = 17), atresia (n = 7), idiopathic incontinence (n = 6), anorectal excision (n = 4), and ileoanal pouch incontinence (n = 4).

MAIN OUTCOME MEASURE: The primary outcomes measured were the Williams continence score and the proportion of patients with a Williams score ≤3 who avoided permanent stoma formation.

RESULTS: Continence improved for the cohort postoperatively at 2 years (2(2–5); p < 0.001) but no significant difference was found between continence scores preoperatively and at 13 years (5(3–6); p = not significant). However, a sustained improvement at 13 years was noted for patients in the anal surgery (3(2–5);p < 0.001) and obstetric injury groups (4.5(3–6); p = 0.001). Twenty-six patients (43%) had a Williams score ≤3 and avoided permanent stoma after 13 years. Eighteen patients developed postoperative rectal evacuatory disorder; 10 of them required a conduit to facilitate colonic irrigation. Postoperative evacuatory disorder was more frequent in patients with a history of obstetric injury (p = 0.008).

LIMITATIONS: This study was limited by the lack of bowel diaries and quality-of-life scores.

CONCLUSION: Gracilis neosphincter is associated with clinically significant and sustained symptom improvement in patients with end-stage fecal incontinence secondary to obstetric injury or anal surgery. These data support the continued use of this procedure in highly selected patients.

© 2014 The American Society of Colon and Rectal Surgeons

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