Double dynamic graciloplasty and coloperineal pull-through after abdominoperineal resection

Geerdes, B. P.; Zoetmulder, F.A.N.; Baeten, C. G. M. I.

doi:10.1016/0959-8049(95)00173-g

Cited by 33 publications

(13 citation statements)

References 18 publications

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“…Während die Gruppe um Cavina und Secchia et al [5,18], welche die gröûte Erfahrung mit dieser Indikation aufweisen von einer ¹guten Kontinenzª (Kontinenz für geformten und flüssigen Stuhl sowie Flatus) in 71 % von 42 Patienten, die intermittierend stimuliert wurden, bzw. in 100 % (9 von 9 Patienten, die kontinuierlich stimuliert wurden) berichten, zeigen Geerdes et al ein erfolgreiches Ergebnis bei 8 von 13 Patienten (61 %) [8].…”

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“…Im Einklang mit allen anderen Autoren, die Erfahrung mit dieser Indikation der dynamischen Gracilisplastik aufweisen, beobachteten auch wir Defaecationsstö-rungen als die am häufigsten auftretende Problematik [1,8,9,18]. Lediglich 3 Patienten gaben an, ihr Rectum aktiv entleeren zu können, während alle übrigen einen Einlauf zur Stimulation der Defaecation benötigten.…”

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“…Viele der in der Literatur berichteten Techniken unterscheiden sich von der unseren insofern, als entweder beide Gracilismuskeln verwendet werden oder daû die Gracilisplastik als ein mehrzeitiges Vorgehen angewandt wird [2±4, 8,9].…”

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“…Die beidseitig stimulierte doppelte Gracilisschlinge wie sie von der Arbeitsgruppe um Baeten im Rahmen der TAR propagiert wurde, erreicht zwar eine rein muskuläre 360 -Umhüllung des ¹Neoanusª [8], welche einen wesentlichen Faktor zur Vermeidung von Darmwandnekrosen darstellt, ist jedoch ein zeitaufwendiges Vorgehen. Durch den Durchzug der Sehne im Rahmen der ¹Split-sling-Technikª erreichten auch wir die gleiche Situation unter bloûer Verwendung eines Muskels.…”

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Analer Schließmuskelersatz mittels dynamischer Gracilisplastik – Ergebnisse der Anwendung an 50 Patienten

Rosén¹,

Ausch²,

Novi³

et al. 1999

Chirurg

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During the period from 1992 to 1998, 50 patients underwent anal sphincter restoration by dynamic graciloplasty for primary (n = 26) or secondary (n = 6) total anorectal reconstruction (TAR) following abdominoperineal rectal resection (APR) or acquired (n = 9) or congenital (n = 9) fecal incontinence, respectively. Forty-seven patients were operated on by a single-stage procedure using a modified technique for the muscle wrap ("split sling"). Muscle fiber transformation by controlled stimulation was achieved at the beginning of the learning curve within 8 weeks and in the meantime within 4 weeks. Rectal injury (n = 10) turned out to be the most serious postoperative complication and was observed mainly in patients following TAR (n = 8). As the most prominent functional problem constipation in patients following TAR hampered the postoperative functional result; however, this was overcome by regular enemas. An improvement in the continence status was observed in 80% of the patients treated for fecal incontinence, and following APR 66% of the patients had acceptable results without a permanent colostomy.

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Analer Schließmuskelersatz mittels dynamischer Gracilisplastik – Ergebnisse der Anwendung an 50 Patienten

Rosén¹,

Ausch²,

Novi³

et al. 1999

Chirurg

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“…In den meisten Fällen sind diese Komplikationen jedoch entweder vermeidbar oder zumindest gut therapierbar [3,16]. [5,7,13].…”

Section: Erfolgsrateunclassified

Sphinkterersatzplastiken

Koch

Baeten

2003

Chirurg

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An anal sphincter replacement graft can be carried out when sphincter lesions occur after unsuccessful conservative or other treatment. Today, two different techniques are used to take over the function of the sphincter. The dynamic gracilis graft can be carried out if a non-atrophied,well innervated m. gracilis is present. This technique is carried out on patients whose incontinence is the result of a trauma,pudendopathy or imperforate anus. It can be extended to the construction of a neo-anus after abdominal resection. The artificial anal sphincter is used whenever the previous method fails or can not be used due to a non-vital, denervated or the lack of the m. gracilis. Older methods such as non-stimulated gracilis, glureus or Thiersch grafts are not commonly used.

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Tissue reactions to bacteria-challenged implantable leads with enhanced infection resistance

Wachem¹,

Blaauw²,

Vries-Hospers

et al. 1998

J. Biomed. Mater. Res.

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Tissue reactions to implantable pacemaker leads were investigated in an early infection model in rabbits. Both standard leads and surface-modified leads were used. The surface modification technique was applied to achieve controlled release of the antibiotic gentamicin. The insulating polyurethane tubing material of the leads was provided with an acrylic acid/acrylamide copolymer surface graft and then loaded with gentamicin. Implantation periods varied from day 4, to week 3 1/2, to week 10. We investigated tissue reactions in the absence of an infectious challenge and also the efficacy of surface-modified leads in preventing infection after challenge with Staphylococcus aureus was evaluated. It was demonstrated that the applied surface modification did not induce adverse effects although during early postimplantation an increase in infiltration of granulocytes and macrophages and wound fluid and fibrin deposition were observed. After bacterial challenge, standard leads were heavily infected at each explantation period, denoted by abscesses, cellular debris, and bacterial colonies. In contrast, little or no infection was observed, either macroscopically or by bacterial cultures, with the surface-modified leads. Microscopy showed little evidence of the bacterial challenge, and that primarily at day 4. It was concluded that the applied surface modification demonstrated enhanced infection resistance and thus represents a sound approach to the battle against infectious complications with biomaterials.

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Double dynamic graciloplasty and coloperineal pull-through after abdominoperineal resection

Cited by 33 publications

References 18 publications

Analer Schließmuskelersatz mittels dynamischer Gracilisplastik – Ergebnisse der Anwendung an 50 Patienten

Analer Schließmuskelersatz mittels dynamischer Gracilisplastik – Ergebnisse der Anwendung an 50 Patienten

Sphinkterersatzplastiken

Tissue reactions to bacteria-challenged implantable leads with enhanced infection resistance

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