Role of adynamic graciloplasty in intractable fecal incontinence: initial results from a tertiary centre in South India

Authors

  • Chandramaliteeswaran Chandrakasan Department of Surgical Gastroenterology, Sri Venkateshwara institute of Medical Sciences, Tirupati, Andhra Pradesh, India
  • Venkatarami Reddy V. Department of Surgical Gastroenterology, Sri Venkateshwara institute of Medical Sciences, Tirupati, Andhra Pradesh, India
  • Dinakar Reddy A. Department of Surgical Gastroenterology, Sri Venkateshwara institute of Medical Sciences, Tirupati, Andhra Pradesh, India
  • Brahmeshwara Rao Musunuru Department of Surgical Gastroenterology, Sri Venkateshwara institute of Medical Sciences, Tirupati, Andhra Pradesh, India
  • Varun Dasari Department of Surgical Gastroenterology, Sri Venkateshwara institute of Medical Sciences, Tirupati, Andhra Pradesh, India
  • Nitesh Naga Balaji Pagadala Department of Surgical Gastroenterology, Sri Venkateshwara institute of Medical Sciences, Tirupati, Andhra Pradesh, India

DOI:

https://doi.org/10.18203/2349-2902.isj20163589

Keywords:

Adynamic graciloplasty, Anal incontinence, Surgery

Abstract

Background: Anal incontinence is a socially crippling disorder affecting up to 2% of general population. For patients with extensive sphincter damage who are not willing for permanent colostomy, either artificial bowel sphincter or muscle transposition like graciloplasty remains the last resort. This study was aimed at reporting the outcomes of adynamic graciloplasty in four of our patients with end stage fecal incontinence.

Methods: This was a prospective observational study of all four patients with end stage fecal incontinence who underwent adynamic graciloplasty from January 2014 to January 2016.

Results: Study group included four patients; etiology was perinatal injury in both female patients and penetrating trauma in both male patients. Surgery was uneventful in all cases. FISI scores improved in all cases.

Conclusions: Adynamic graciloplasty is safe and feasible option in surgical management of select cases of intractable fecal incontinence with satisfactory results. It may be offered as a salvage surgery before condemning these patients to permanent colostomy.

References

Nelson R, Norton N, Cautley E, Furner S. Community-based prevalence of anal incontinence. JAMA. 1995;274(7):559-61.

Oø R. Fecal incontinence. Studies on physiology, pathophysiology and surgical treatment. Dan Med Bull. 2003;50(3):262-82.

Belyaev O, Müller C, Uhl W. Neosphincter surgery for fecal incontinence: a critical and unbiased review of the relevant literature. Surg Today. 2006;36(4):295-303.

Pickrell KL, Broadbent TR, Masters FW, Metzger JT. Construction of a rectal sphincter and restoration of anal continence by transplanting the gracilis muscle; a report of four cases in children. Ann Surg. 1952;135(6):853-62.

Corman ML. Gracilis muscle transposition for anal incontinence: Late results. Br J Surg. 1985;72(S1):s21-2.

Faucheron JL, Hannoun L, Thome C, Parc R. Is fecal continence improved by nonstimulated gracilis muscle transposition? Dis Colon Rectum. 1994;37(10):979-83.

Hallan RI, Williams NS, Hutton MRE, Scott M, Pilot MA, Swash M, et al. Electrically stimulated sartorius neosphincter: Canine model of activation and skeletal muscle transformation. Br J Surg. 1990;77(2):208-13.

Dickson JAS, Nixon HH. Control by electronic stimulator of incontinence after operation for anorectal agenesis. J Pediatr Surg. 1968;3(6):696-701.

Baeten C. Dynamic graciloplasty for treatment of faecal incontinence. The Lancet. 1991;338(8776):1163-5.

Williams P. Development of an electrically stimulated neoanal sphincter. The Lancet. 1991;338(8776):1166-9.

Chapman AE, Geerdes B, Hewett P, Young J, Eyers T, Kiroff G, et al. Systematic review of dynamic graciloplasty in the treatment of faecal incontinence. Br J Surg. 2002;89(2):138-53.

Penninckx F. Belgian experience with dynamic graciloplasty for faecal incontinence. Br J Surg. 2004;91(7):872-8.

Barišić G, Krivokapić Z. Adynamic and dynamic muscle transposition techniques for anal incontinence. Gastroenterol Rep. 2014;2(2):98-105.

Rockwood DTH, Church JM, Fleshman JW, Kane RL, Mavrantonis C, Thorson AG, et al. Fecal incontinence quality of life scale. Dis Colon Rectum. 2000;43(1):9-16.

Rockwood TH, Church JM, Fleshman JW, Kane RL, Mavrantonis C, Thorson AG, et al. Patient and surgeon ranking of the severity of symptoms associated with fecal incontinence: the fecal incontinence severity index. Dis Colon Rectum. 1999;42(12):1525-31.

Corman ML. Management of fecal incontinence by gracilis muscle transposition. Dis Colon Rectum. 1979;22(5):290-2.

Walega P, Romaniszyn M, Siarkiewicz B, Zelazny D. 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. Gastroenterol Res Pract. 2015;2015:1-5.

Rothbarth J, Bemelman WA, Meijerink WJ, Stiggelbout AM, Zwinderman AH, Buyze-Westerweel ME, et al. What is the impact of fecal incontinence on quality of life? Dis Colon Rectum. 2001;44(1):67-71.

Bordeianou L, Rockwood T, Baxter N, Lowry A, Mellgren A, Parker S. Does incontinence severity correlate with quality of life? Prospective analysis of 502 consecutive patients. Colorectal Dis Off J Assoc Coloproctology GB Irel. 2008;10(3):273-9.

Dedeli O, Fadiloglu C, Bor S. Validity and reliability of a Turkish version of the Fecal incontinence quality of life scale. J Wound Ostomy Cont Nurs Off Publ Wound Ostomy Cont Nurses Soc WOCN. 2009;36(5):532-8.

Dehli T, Martinussen M, Mevik K, Stordahl A, Sahlin Y, Lindsetmo RO, et al. Translation and validation of the Norwegian version of the fecal incontinence quality-of-life scale. Scand J Surg SJS Off Organ Finn Surg Soc Scand Surg Soc. 2011;100(3):190-5.

Tsunoda A, Yamada K, Kano N, Takano M. Translation and validation of the Japanese version of the fecal incontinence quality of life scale. Surg Today. 2013;43(10):1103-8.

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Published

2016-12-10

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Original Research Articles