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Long-term results of dynamic graciloplasty for severe fecal incontinence

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Abstract

Background

Fecal incontinence is a common complaint. In the presence of extensive sphincter deterioration, after anorectal trauma, or failure of non-invasive surgical procedures, a sphincter reconstruction with dynamic graciloplasty can be proposed. The aim of our study was to evaluate the long-term results of dynamic graciloplasty.

Methods

A retrospective study was conducted on all the patients who underwent dynamic graciloplasty between 1997 and 2019 in one French tertiary referral center for severe fecal incontinence after previous unsuccessful treatments. Only patients with available long-term results (≥ 1 year) were included.

Results

Among 40 patients who underwent dynamic graciloplasty, 31 patients [77% women, median age = 57 years (range 17–74 years)] were included with a mean long-term follow-up of 11 ± 6 years. The mean duration of fecal incontinence was 8 ± 7.9 years and the mean Wexner score was 16 ± 3. Fecal incontinence was adult-acquired in 88% of patients. 74% of patients underwent previously unsuccessful surgical procedures. A diverting colostomy was present in 7 patients (23%). Postoperative overall, surgical and major morbidity occurred in 20 (64%), 17 (55%) and 7 (23%) patients, respectively.

At the end of follow-up, 18 patients still used their stimulation device (58%), and 4 patients required a permanent colostomy (12.5%). Long-term efficacy of dynamic graciloplasty was reported by 17 patients (55%).

Conclusion

The efficacy of dynamic graciloplasty is conserved in 55% of patients after a mean follow-up of 11 years. This procedure needs to be kept in the surgical armamentarium for persistent and severe fecal incontinence after previous surgical interventions or in the presence of large perineal defects, before the ultimate step of permanent stoma.

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Authors and Affiliations

  1. Department of Digestive Surgery, Timone University Hospital, Aix Marseille Univ, APHM, Marseille, France

    D. Mege, A. Omouri, A. Maignan & I. Sielezneff

Authors
  1. D. Mege
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  2. A. Omouri
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  3. A. Maignan
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  4. I. Sielezneff
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Correspondence to D. Mege.

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The authors declare that they have no competing interest.

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This study was conducted according to the ethical standards of the Committee on Human Experimentation.

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All the patients provided written informed consent and data were collected anonymously.

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Mege, D., Omouri, A., Maignan, A. et al. Long-term results of dynamic graciloplasty for severe fecal incontinence. Tech Coloproctol 25, 531–537 (2021). https://doi.org/10.1007/s10151-021-02421-y

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