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Graciloplasty for Anal Incontinence—Is Electrical Stimulation Necessary?

Gohil, Amish Jayantilal, MCh (Plastic & Reconstructive Surgery)*; Gupta, Ashish Kumar, MCh (Plastic & Reconstructive Surgery)*; Jesudason, Mark Ranjan, MS, DNB, MRCS (Ed); Nayak, Sukria, MBBS, MS, FRCS (G)

doi: 10.1097/SAP.0000000000001770
Reconstructive Surgery
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Introduction Anal incontinence brings lot of social embarrassment, mental distress, dignity loss, anxiety, low confidence, and eventually a low self-esteem with a restricted social life to the affected person. Surgical repair is the mainstay of treatment for anal incontinence. However, some patients need additional procedures such as gluteoplasty, graciloplasty (adynamic and dynamic), artificial bowel sphincter, and sacral nerve stimulation, which help to reinforce or augment the anal sphincter.

Methods A retrospective analysis of 17 patients who underwent adynamic graciloplasty for reconstruction of anal sphincter from January 2008 to December 2017 was done. Demographic profile, fecal incontinence scores (Wexner score and KAMM score), and anal manometric findings were recorded pregraciloplasty and postgraciloplasty.

Results Of the total 17 patients, 9 were males and 8 were females. Satisfactory continence was achieved in 13 patients out of 17 (76.47%). Continence was defined as satisfactory for patients having a postoperative Wexner score of 2 or less and KAMM score of 4 or less. It was considered to be poor if the Wexner score was greater than 6 and KAMM score was greater than 8 in the follow-up period or if the stoma was not reversed.

Conclusions Unstimulated or adynamic graciloplasty is a relatively safe procedure, has a short learning curve, is affordable, and avoids the additional implant-related complications. We feel that the unstimulated graciloplasty still has a significant role in the management of anal incontinence.

From the *Department of Plastic & Reconstructive Surgery, and

Department of General Surgery, Christian Medical College, Vellore, Tamilnadu, India.

Received August 7, 2018, and accepted for publication, after revision October 23, 2018.

Conflicts of interest and sources of funding: none declared.

Reprints: Amish Jayantilal Gohil, MCh (Plastic & Reconstructive Surgery), Department of Plastic Surgery, Unit-II, Paul Brand Bldg, Christian Medical College & Hospital, Vellore, 632004 Tamilnadu, India. E-mail: amishjg@gmail.com.

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