Dynamic graciloplasty for severe anal incontinence

Abstract

Background: The surgical options for the treatment of anal incontinence where standard procedures have failed include transposition of striated muscles, primarily gracilis and gluteus maximus, and implantation of artificial sphincters. Due to a high proportion of fatigue-prone fibres in striated muscles, the results of transposition without stimulation have been disappointing. This study presents the results of stimulated graciloplasty in 13 patients with severe anal incontinence in whom other surgical procedures had failed. Methods: The gracilis muscle was transposed around the anal canal according to a previously described technique. Eight weeks later the intramuscular electrodes were implanted into the gracilis at the site of the nerve entry and a neurostimulator was placed in a subcutaneous pocket in the abdominal wall. The patients were followed from 7 to 27 months. Results: Six patients obtained satisfactory continence and five showed marked improvement. Two patients were considered failures. Rectal evacuation problems occurred in three patients, in one so severe that the patient, in spite of satisfactory continence, considered the treatment a failure. Conclusion: Dynamic graciloplasty is a viable option in carefully selected patients with severe anal incontinence where other methods have failed.