Dynamic Graciloplasty

Abstract

Dynamic graciloplasty is a transposition of the gracilis muscle around the anus and has its effect through an electrical stimulation, forcing the muscle to contract. The muscle will change its fibre pattern by this stimulation so that it becomes non-fatigable. This operation is indicated for patients who are incontinent for feces and have no other treatment option than a colostomy; that is for patients with a destroyed anal sphincter or a sphincter that is denervated or not at all existent. The technique includes the implantation of two intramuscular electrodes and an implantable stimulator. The gracilis muscle is trained by gradually increasing the frequency of the stimulation pulses to a muscle fibre composition of predominantly type1fibres. These fibres generate a contraction that is less forceful, but can be sustained for hours. The results of this operation show a success rate of 56–80%, but this is obtained at the cost of many complications, most of which were preventable or treatable. Overall, this operation is a good solution for patients who lost their sphincter function and can not benefit any more from conservatory treatments or conventional operations.