Dynamic versus Adynamic Graciloplasty in Treatment of End-Stage Fecal Incontinence: Is the Implantation of the Pacemaker Really Necessary? 12-Month Follow-Up in a Clinical, Physiological, and Functional Study.

Piotr Walega,Benita Siarkiewicz,Michal Romaniszyn,Dorota Zelazny

doi:10.1155/2015/698516

Piotr Walega, Benita Siarkiewicz + Show 2 more

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https://doi.org/10.1155/2015/698516

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Abstract

Purpose. The aim of the study is to compare functional results of end-stage fecal incontinence treatment with dynamic graciloplasty and adynamic graciloplasty augmented with transanal conditioning of the transposed muscle. Methods. A total of 20 patients were qualified for graciloplasty procedure due to end-stage fecal incontinence. 7 patients underwent dynamic graciloplasty (DGP), whereas 13 patients were treated with adynamic graciloplasty, with transanal stimulation in the postoperative period (AGP). Clinical, functional, and quality of life assessments were performed 3, 6, and 12 months after the procedures. Results. There were no intraoperative or early postoperative complications. The detachment of gracilis muscle tendon was observed in one patient in DGP group and two in AGP group. There was a significant improvement of Fecal Incontinence Quality of Life (FIQL) and Fecal Incontinence Severity Index (FISI) scores in both groups 12 months after procedure. Anorectal manometry showed improvement regarding basal and squeeze pressures in both groups, with significantly better squeeze pressures in AGP group. Conclusions. The functional effects in the DGP and AGP groups were similar. Significantly lower price of the procedure and avoidance of implant-related complication risk suggest the attractiveness of the AGP method augmented by transanal stimulation.

Highlights

7–10% of the working population suffers from fecal incontinence, about 30% of which is affected by the end-stage of the disease
Despite the fact that dynamic graciloplasty became more popular than its unstimulated variant, Rosen et al showed that after initial conditioning of the transposed muscle even half of the patients no longer benefit from electrostimulation a year after the treatment [4]
In this study, based on the IFGD guidelines, the following stages of research were used (i) identification and assessment of the epidemiological control of defecation based on subjective data, function tests, electrophysiological measurements, and imaging, (ii) the patient division into two groups: (a) patients treated by dynamic graciloplasty (DGP) and (b) patients treated by adynamic graciloplasty (AGP), (iii) analysis of complications during and after surgery and functional tests 3,6, and 12 months after surgery, (iv) assessment of the Fecal Incontinence Severity Index (FISI) [7] and Fecal Incontinence Quality of Life (FIQL) at 3, 6, and 12 months after surgery

Summary

Introduction

7–10% of the working population suffers from fecal incontinence, about 30% of which is affected by the end-stage of the disease. This includes patients with congenital absence of the anal sphincter, patients after surgical treatment of the anus and rectum, and after major perineal trauma, the spinal injury or damage of peripheral innervation of sphincters [1], who in most cases do not respond to conservative measures, such as biofeedback training or electrical stimulation, and are not eligible for surgical repair, such as sphincteroplasty. Most commonly used procedures are the unstimulated graciloplasty (AGP) and dynamic (stimulated) graciloplasty (DGP), which were proven successful in highly selected patients [3].

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Results