La graciloplastie dynamisée dans le traitement de l’incontinence fécale sévère. Étude rétrospective multicentrique française

Abstract

The aim of this study was to retrospectively assess the safety and efficacy of dynamic graciloplasty performed in 5 French surgical centers involved in the treatment of fecal incontinence. Patients and methods: Between March 1994 and March 2000, a total of 24 patients were treated with dynamic graciloplasty for fecal incontinence excluding case of anal reconstruction for cancer. Intramuscular leads and neurostimulators were implanted to stimulate the transposed gracilis. Continence and safety were evaluated using patients’ records during hospitalisation and during the out-patient visit or further hospitalisation. Results: No death occured. A successful functional outcome was reported for 19 patients (79%) during the follow up period. Twenty-two complications occured including wound. Wound infection in 6 patients and tendon detachement in 4. One patient presented with an infected anal erosion leading to material explantation. Conclusion: Dynamic graciloplasty is an effective procedure for patients with refractory fecal incontinence. However, the procedure has significant morbidity which seems to be correlated with the surgeons’experience. Morever, this procedure should now be compared to the artificial anal sphincter.