Dynamic graciloplasty

Abstract

Dynamic graciloplasty (DGP) is a surgical procedure which can be used in end-stage fecal incontinence for traumatic destruction of anal sphincters or in total anorectal reconstruction (TAR) of patients, submitted to abdominoperineal excision (APE), strongly determined to avoid a terminal abdominal stoma. The operation consists in the transposition, around the anorectum or perineal colostomy, of a fatigable muscle (like the gracilis muscle) which is continuously stimulated by implantable electrodes connected to an electronic stimulator device; the aim is to train the gracilis to behave as a fatigue-resistant muscle and act as an anal sphincter. Despite the significant number of complications related to this surgical procedure, the existence of other treatments for fecal incontinence, and the high level of patient cooperation required, the operation can still have a role in selected patients.