Long-Term Efficacy of Dynamic Graciloplasty for Fecal Incontinence

Wexner, Steven D.; Baeten, C. G. M. I.; Bailey, H. Randolph; Bakka, Arne; Belin, Bruce; Belliveau, Paul; Berg, E.; Buie, W. Donald; Burnstein, Marcus J.; Christiansen, John; Coller, John A.; Galandiuk, Susan; Lange, Jochen; Madoff, Robert D.; Matzel, Klaus E.; Påhlman, Lars; Parc, R; Reilly, John P.; Seccia, Massimo; Thorson, Alan G.; Vernava, Anthony M.

doi:10.1007/s10350-004-6302-1

Cited by 130 publications

(95 citation statements)

References 24 publications

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“…Wexner and colleagues 31 reported that at 2 years postoperation, out of 115 patients from a multicentre study, 15% were completely continent and 42% had 50-99% continence; it is not clear whether 'continence' implied continence to solid and liquid stool. This compares with the RLH ESGNS study where, at 2 years, 17% were never incontinent to solid or liquid stool and 47% were incontinent less than once per week.…”

Section: Comparison Of Our Results With Previously Published Seriesmentioning

confidence: 99%

“…Recent multicentre [29][30][31] studies have confirmed that, for between 50 and 70% of patients, ESGNS can improve or restore continence. A high incidence of major morbidity, including ongoing bowel evacuatory disorders, has been reported.…”

Section: The Evidence Basementioning

confidence: 99%

“…Of the total of 248 RLH admissions, for 48 patients over half were due to complications, the majority occurring after the end of primary treatment. The commonest hospitalised complications were related to evacuation difficulties or pain (33) and infective (31) or circuitry problems (23). Following completion of primary treatment, admissions to RLH resulted in an average of 20 inpatient bed days per patient during the study follow-up period.…”

Section: Summary Of Esgns Outcomes At the Royal Londonmentioning

confidence: 99%

See 2 more Smart Citations

Outcomes of electrically stimulated gracilis neosphincter surgery

Tillin

Chambers²,

Feldman³

2005

Health Technol Assess

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Section: Comparison Of Our Results With Previously Published Seriesmentioning

confidence: 99%

Section: The Evidence Basementioning

confidence: 99%

Section: Summary Of Esgns Outcomes At the Royal Londonmentioning

confidence: 99%

See 1 more Smart Citation

Outcomes of electrically stimulated gracilis neosphincter surgery

Tillin

Chambers²,

Feldman³

2005

Health Technol Assess

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“…La NRS surge como resultado del desarrollo de la neurofisiología defecatoria, como una opción terapéutica para los casos con IF sin defecto anatómico objetivable, en los que históricamente ha existido un vacío terapéutico (6,10,17). La NRS, mediante la estimulación eléctrica de las fibras sensoriales aferentes sacras, consigue una mejora en el equilibrio de interacción entre las distintas estructuras implicadas en el mecanismo defecatorio, actuando sobre centros reflejos neurológicos (no sólo medulares, sino también pontinos), con repercusiones a nivel de la contractilidad, distensibilidad y sensibilidad rectal (24,25). Así, a través de la estimulación de fibras aferentes sacras, se produce una neuromodulación sobre los centros reflejos defecatorios, dando como resultado una mejora sobre la continencia anal (6,10,17).…”

Section: Discussionunclassified

Neuromodulación de raíces sacras como tratamiento de la incontinencia fecal: Resultados preliminares

Navarro

Sebastián

Vicente

et al. 2007

Rev. esp. enferm. dig.

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INTRODUCCIÓNLa incontinencia fecal (IF) se define como la incapacidad de diferir la defecación hasta que se encuentra el lugar y el momento socialmente idóneos para realizarla, produciéndose una pérdida recurrente e involuntaria de material fecal o gases a través del canal anal. Aún en los casos más leves de IF (en donde únicamente se producen escapes y ensuciamientos de la ropa interior), esta patología conlleva en mayor o menor medida problemas físicos, psicológicos y alteraciones en la calidad de vida de los pacientes (en los ámbitos sexual, familiar, social y laboral) (1-3). Vol. 99. N.°11, pp. 636-642, 2007 Recibido: 20-05-07. Aceptado: 10-09-07. RESUMENPresentamos nuestra experiencia inicial en el tratamiento de la incontinencia fecal (IF) mediante neuromodulación de raíces sacras (NRS), a través de los resultados de un estudio prospectivo realizado con 26 pacientes en el que se comparan los valores basales en la escala de continencia de Wexner-Cleveland y en la capacidad para el retraso de la defecación, con los obtenidos tras un año de terapia con NRS. El estudio inicial de cada paciente incluía anamnesis, exploración general, ecografía y manometría rectal, así como unos diarios de continencia y de calidad de vida específicos para la IF de 3 semanas. Antes de la terapia con NRS, el valor medio en la escala Wexner-Cleveland fue de 15,00 ± 1,81 y el 62,50% de los pacientes tenía una capacidad de retraso de la defecación menor de 1 minuto. Tras un año de terapia con NRS, el valor medio en la escala de Wexner-Cleveland fue de 4,87 ± 2,54 (p = 0,0031) y el 75,01% de los pacientes presentaba una capacidad de retraso defecatorio mayor de 15 minutos (p = 0,0018). Hacemos, además, una descripción detalla de la técnica quirúrgica de la NRS, haciendo referencia a sus indicaciones y finalizamos revisando las distintas opciones terapéuticas para la IF mostrando nuestro algoritmo terapéutico para esta patología. La NRS es una técnica eficaz para el tratamiento de la IF en pacientes seleccionados que no han respondido a tratamiento conservador, biofeedback o correcciones anató-micas (esfinteroplastia), con una mínima morbilidad y susceptible de realizarse en un programa de cirugía ambulatoria.Palabras clave: Incontinencia fecal. Neuromodulación. Raíces sacras. ABSTRACTWe present our initial experience in the treatment of fecal incontinence (FI) with sacral root neuromodulation (SRN) by reporting the results of a prospective study with 26 patients where baseline Wexner-Cleveland scale scores and ability to delay defecation were compard to results after one year with SRN. The initial study of patients included history taking, general examination, anal ultrasonography, and manometry, and a three-week diary of continence and quality of life specific for FI was used. Before SRN the mean baseline Wexner-Cleveland score was 15.00 ± 1.81, and 62.50% of patients could only delay defecation for less than a minute. After a year with NRS the mean Wexner-Cleveland score was 4.87 ± 2.54 (p = 0.0031), and 75.01% of patients coul...

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“…Otra técnica es la graciloplastía dinámica, que es la creación de un esfínter con músculo gracilis que ha sido sometido a estimulación eléctrica continua, lográndose de esta manera resistencia a la fatiga. Estos métodos se emplean en pacientes con lesiones estructurales graves del esfínter y consiguen la mejoría de la incontinencia en aproximadamente el 60% de los pacientes a corto plazo y 62% a 2 años de seguimiento 34 .…”

Section: Neoesfínteresunclassified

Incontinencia fecal del adulto

A¹,

M²,

G³

et al. 2011

Rev Chil Cir

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Fecal incontinence in adultsThe aim of this paper is to review the knowledge of this pathology by highlighting the clinical evolution, study and treatment. These different aspects need a multidisciplinary approach, because of their complex physiopathology, possible association with urinary incontinence and prolapse of the three compartments of the pelvis. The fecal incontinence (FI) constitutes a highly prevalent pathology that affects at least 2% of the population and up to 45% of the patients in nursing homes. This pathology can cause serious problems in physical, psychological, social, and economical levels. The clinical evaluation may identify or suspect the cause, and guide the study of FI. The initial treatment of the FI should always be medical one, often associated to biofeedback and the surgical treatment should be only reserved for refractory FI. Sphincteroplasty is indicated by defi ned defaults of the external sphincter, with good initial results (at least 70%) that fall to 50% in 5 years. The artifi cial neosphincter and the dynamic graciloplasty represent an option for patient without suffi cient sphincter mass for a plasty. In the last few years new techniques have appear with promising results, as the neuromodulation that uses electrodes in the sacral plexus or applied to the posterior tibial nerve. In conclusion the IF is a problem of large prevalence but kept in shadows because the patients tend to have reticence to declare it, and the doctors to inquire about. The focus should be multidisciplinary and the initial treatment must be medical one. The surgical treatment should be reserved for refractory FI.Key words: Fecal incontinence, endosonography, anal manometry, biofeedback, sphincteroplasty. ResumenEl propósito de esta revisión es actualizar los conocimientos sobre esta patología, destacando su evolución clínica, estudio y tratamiento, aspectos que ameritan un enfoque multidisciplinario, ya que, además de su compleja fi siopatología, puede asociarse a incontinencia urinaria y prolapso de los tres compartimentos de la pelvis. La incontinencia fecal (IF) constituye una patología altamente prevalente que afecta al menos un 2% de la población y hasta el 45% de los pacientes en casas de reposo; cuyas consecuencias pueden ocasionar al paciente serios problemas físicos, psicológicos, sociales y económicos. La evaluación clínica puede identifi car o sospechar la causa de la IF, y guiar el estudio de la misma. El tratamiento inicial de la IF debe ser siempre médico, a menudo asociado a biofeedback, y el tratamiento quirúrgico reservarse para la IF refractaria a estas

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Long-Term Efficacy of Dynamic Graciloplasty for Fecal Incontinence

Cited by 130 publications

References 24 publications

Outcomes of electrically stimulated gracilis neosphincter surgery

Outcomes of electrically stimulated gracilis neosphincter surgery

Neuromodulación de raíces sacras como tratamiento de la incontinencia fecal: Resultados preliminares

Incontinencia fecal del adulto

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