Prospective study of artificial anal sphincter and dynamic graciloplasty for severe anal incontinence

Since the early 1900s, skeletal muscle transpositions have been employed for complicated cases of fecal incontinence to augment or replace the anal sphincter. Multiple techniques have evolved that vary with the type and configuration of muscle used in the reconstruction. Transposition of the gluteus maximus muscle was popular in the early stages of development but was replaced by techniques involving transposition of the gracilis muscle. Within the past 16 years, electrical stimulators have been applied to the transposed muscle flaps to create a dynamic reconstruction improving the efficacy of these neosphincters over their static counterparts. However, the stimulated versions are technically demanding with a high rate of morbidity secondary to complications of the multiple components and variations in technique. The stimulator used in this procedure has been removed from the US market, although it is still available in other countries. Currently in the United States, gracilis transposition is still employed in the absence of an electrical stimulator as an adjunct to the artificial bowel sphincter (Acticon Neosphincter TM , American Medical Systems, Minnetonka, MN), such as in cases of severe muscle loss and congenital atresia. In European countries, the stimulated graciloplasty continues to evolve, leading to expansion of its use in total anorectal reconstruction for anal atresia and after abdominoperineal resection. KEYWORDS: Fecal incontinence, muscle transposition, graciloplasty, gluteoplasty, neosphincter constructionObjectives: Upon completion of this article, the reader should be able to: (1) list current therapeutic options for failed overlapping sphincteroplasty; and (2) evaluate the results of each of these procedures.Patients with severe fecal incontinence unresponsive to conservative measures can be divided into two broad categories of surgical approach. The first group includes those patients with an identifiable anatomic sphincter defect who can expect a 40 to 60% long-term surgical success rate with overlapping sphincteroplasty.1 The absence of pudendal neuropathy yields the best outcome in these patients. 2 The second group includes those patients with extensive sphincter damage, muscle loss, or pudendal neuropathy not amenable to direct sphincter repair. With the widespread prevalence of fecal incontinence and development of newer surgical techniques, the patient with severe fecal incontinence is seldom obligated to a permanent stoma. Neosphincter

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“…Though the ABS was found to be more effective in improving continence scores. 41 However, larger long-term studies are needed.…”

Section: Discussionmentioning

confidence: 99%

Muscle Transposition: Does It Still Have a Role?

Susan

Wexner

2005

Clinics in Colon and Rectal Surgery

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“…34 A small single-center prospective study comparing the artificial bowel sphincter to graciloplasty for fecal incontinence slightly favored the artificial bowel sphincter, but complications were common in both groups. 35…”

Section: Management Of Rectal Injuriesmentioning

confidence: 99%

Care of the Patient with Anorectal Trauma

Herzig

2012

Clinics in Colon and Rectal Surgery

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Blunt and penetrating injuries to the anus and rectum are uncommon. Considerable debate remains regarding the optimal treatment of rectal injuries. Although intraperitoneal rectal injuries can be treated similarly to colonic injuries, treatment options for extraperitoneal injuries include fecal diversion with a colostomy, presacral drainage, repair of the rectal defect, and distal rectal washout. Perineal injuries resulting in anal sphincter disruption often occur with severe associated injuries. Small defects can be repaired primarily, but extensive injuries often require diversion and sphincter reconstruction.

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“…46 A prospective controlled study comparing dynamic graciloplasty with artificial anal sphincter in 16 patients 8 in each group showed that both of the two procedures had a high incidence of technical failures and complication requiring re-operation. 47 Chapman et al 48 reported a systematic review article of this procedure, where they searched articles published until November 1999, and found 40 articles met the inclusion criteria. Mortality rates were around 2% for both graciloplasty and colostomy.…”

Section: Surgical Treatmentmentioning

confidence: 99%

Neurologic fecal incontinence

Wyndaele

Kovindha

Igawa

et al. 2009

Neurourology and Urodynamics

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Introduction: This manuscript summarizes the work of Committee 10 on neurologic bladder and bowel of the International Consultation on Incontinence in [2008][2009]. As the data are very large the outcome is presented in different manuscripts. This manuscript deals with neurologic fecal incontinence (FI). Methods: Through in debt literature review all aspects of neurologic urinary and FI were studied for levels of evidence. Recommendations for diagnosis and treatment, and for future research were made. Results: Pathophysiology was summarized for different levels of lesions. For epidemiology, specific diagnostics, conservative treatment, and surgical treatment of neurologic FI levels of evidence and grades of recommendation were made. Conclusions: Though data are available that advice and guide in the management of FI in neurologic patients, not many data are with a high level of evidence or high grade of recommendation. More and well-structured research is needed.

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Prospective study of artificial anal sphincter and dynamic graciloplasty for severe anal incontinence

Cited by 38 publications

References 18 publications

Muscle Transposition: Does It Still Have a Role?

Muscle Transposition: Does It Still Have a Role?

Care of the Patient with Anorectal Trauma

Neurologic fecal incontinence

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