Long-term results of dynamic graciloplasty for severe fecal incontinence

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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References

  1. 1.

    Bochenska K, Boller A-M (2016) Fecal incontinence: epidemiology, impact, and treatment. Clin Colon Rectal Surg 29:264–270

    Article  Google Scholar 

  2. 2.

    Damon H, Guye O, Seigneurin A et al (2006) Prevalence of anal incontinence in adults and impact on quality-of-life. Gastroenterol Clin Biol 30:37–43

    Article  Google Scholar 

  3. 3.

    Ruiz NS, Kaiser AM (2017) Fecal incontinence—challenges and solutions. World J Gastroenterol 23:11–24

    Article  Google Scholar 

  4. 4.

    Imhoff LR, Brown JS, Creasman JM et al (2012) Fecal incontinence decreases sexual quality of life, but does not prevent sexual activity in women running head: anal incontinence and sexual function. Dis Colon Rectum 55:1059–1065

    Article  Google Scholar 

  5. 5.

    Drossman DA, Li Z, Andruzzi E et al (1993) US householder survey of functional gastrointestinal disorders. Prevalence, sociodemography, and health impact. Dig Dis Sci 38:1569–1580

    CAS  Article  Google Scholar 

  6. 6.

    Filce HG, LaVergne L (2015) Absenteeism, educational plans, and anxiety among children with incontinence and their parents. J Sch Health 85:241–250

    Article  Google Scholar 

  7. 7.

    Patton V, Parkin K, Moore KL (2018) A prospective “bottom up” study of the costs of faecal incontinence in ambulatory patients. Neurourol Urodyn 37:1672–1677

    Article  Google Scholar 

  8. 8.

    Dunivan GC, Heymen S, Palsson OS et al (2010) Fecal incontinence in primary care: prevalence, diagnosis, and health care utilization. Am J Obstet Gynecol 202:493.e1–6

    Article  Google Scholar 

  9. 9.

    Lee YY (2014) What’s new in the toolbox for constipation and fecal incontinence? Front Med 1:5

    Article  Google Scholar 

  10. 10.

    Pickrell KL, Broadbent TR, Masters FW, Metzger JT (1952) Construction of a rectal sphincter and restoration of anal continence by transplanting the gracilis muscle: a report of four cases in children. Ann Surg 135:853–862

    CAS  Article  Google Scholar 

  11. 11.

    Konsten J, Baeten CG, Havenith MG, Soeters PB (1993) Morphology of dynamic graciloplasty compared with the anal sphincter. Dis Colon Rectum 36:559–563

    CAS  Article  Google Scholar 

  12. 12.

    Baeten CGMI, Konsten J, Soeters PB et al (1991) Dynamic graciloplasty for treatment of faecal incontinence. Lancet 338:1163–1165

    CAS  Article  Google Scholar 

  13. 13.

    Williams NS, Patel J, George BD, Hallan RI, Watkins ES (1991) Development of an electrically stimulated neoanal sphincter. Lancet 338:1166–1169

    CAS  Article  Google Scholar 

  14. 14.

    Sielezneff I, Malouf AJ, Bartolo DCC, Pryde A, Douglas S (1999) Dynamic graciloplasty in the treatment of patients with faecal incontinence. Br J Surg 86:61–65

    CAS  Article  Google Scholar 

  15. 15.

    Madoff RD, Rosen HR, Baeten CG et al (1999) Safety and efficacy of dynamic muscle plasty for anal incontinence: lessons from a prospective, multicenter trial. Gastroenterology 116:549–556

    CAS  Article  Google Scholar 

  16. 16.

    Danielson J, Karlbom U, Wester T, Graf W (2019) Long-term outcome after dynamic graciloplasty for treatment of persistent fecal incontinence in patients with anorectal malformations. Eur J Pediatr Surg 29:276–281

    Article  Google Scholar 

  17. 17.

    Jorge JM, Wexner SD (1993) Etiology and management of fecal incontinence. Dis Colon Rectum 36:77–97

    CAS  Article  Google Scholar 

  18. 18.

    Gallas S, Michot F, Faucheron JL et al (2011) Predictive factors for successful sacral nerve stimulation in the treatment of faecal incontinence: results of trial stimulation in 200 patients. Colorectal Dis 13:689–696

    CAS  Article  Google Scholar 

  19. 19.

    Sans A, Mege D, Sielezneff I (2017) One-stage dynamic graciloplasty for anal incontinence. J Visc Surg 154:437–448

    CAS  Article  Google Scholar 

  20. 20.

    Dindo D, Demartines N, Clavien P-A (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213

    Article  Google Scholar 

  21. 21.

    von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP (2007) The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. Lancet 370:1453–1457

    Article  Google Scholar 

  22. 22.

    Ortiz H, Armendariz P, DeMiguel M, Solana A, Alós R, Roig JV (2003) Prospective study of artificial anal sphincter and dynamic graciloplasty for severe anal incontinence. Int J Colorectal Dis 18:349–354

    CAS  Article  Google Scholar 

  23. 23.

    Baeten CG, Uludag O, Rongen MJ (2001) Dynamic graciloplasty for fecal incontinence. Microsurgery 21:230–234

    CAS  Article  Google Scholar 

  24. 24.

    Bresler L, Reibel N, Brunaud L et al (2002) Dynamic graciloplasty in the treatment of severe fecal incontinence. French multicentric retrospective study Ann Chir 127:520–526

    CAS  PubMed  Google Scholar 

  25. 25.

    Rongen M-JGM, Uludag O, El Naggar K, Geerdes BP, Konsten J, Baeten CGMI (2003) Long-term follow-up of dynamic graciloplasty for fecal incontinence. Dis Colon Rectum 46:716–721

    Article  Google Scholar 

  26. 26.

    Hassan MZM, Rathnayaka MMG, Deen KI (2010) Modified dynamic gracilis neosphincter for fecal incontinence: an analysis of functional outcome at a single institution. World J Surg 34:1641–1647

    CAS  Article  Google Scholar 

  27. 27.

    Thornton MJ, Kennedy ML, Lubowski DZ, King DW (2004) Long-term follow-up of dynamic graciloplasty for faecal incontinence. Colorectal Dis 6:470–476

    CAS  Article  Google Scholar 

  28. 28.

    Sielezneff I, Malouf AJ, Bartolo DC (1998) De Palma staple to fix the tendon in stimulated graciloplasty. Dis Colon Rectum 41:1461–1462

    CAS  Article  Google Scholar 

  29. 29.

    Tillin T, Gannon K, Feldman RA, Williams NS (2006) Third-party prospective evaluation of patient outcomes after dynamic graciloplasty. Br J Surg 93:1402–1410

    CAS  Article  Google Scholar 

  30. 30.

    Geerdes BP, Heineman E, Konsten J, Soeters PB, Baeten CG (1996) Dynamic graciloplasty. Complications and management. Dis Colon Rectum 39:912–917

    CAS  Article  Google Scholar 

  31. 31.

    Gohil AJ, Gupta AK, Jesudason MR, Nayak S (2019) Graciloplasty for anal incontinence-is electrical stimulation necessary? Ann Plast Surg 82:671–678

    CAS  Article  Google Scholar 

  32. 32.

    Pickrell K, Masters F, Georgiade N, Horton C (1954) Rectal sphincter reconstruction using gracilis muscle transplant. Plast Reconstr Surg 13:46–55

    CAS  Article  Google Scholar 

  33. 33.

    Sonnino RE, Reinberg O, Bensoussan AL, Laberge JM, Blanchard H (1991) Gracilis muscle transposition for anal incontinence in children: long-term follow-up. J Pediatr Surg 26:1219–1223

    CAS  Article  Google Scholar 

  34. 34.

    Baeten CG, Geerdes BP, Adang EM et al (1995) Anal dynamic graciloplasty in the treatment of intractable fecal incontinence. N Engl J Med 332:1600–1605

    CAS  Article  Google Scholar 

  35. 35.

    Wexner SD, Baeten C, Bailey R et al (2002) Long-term efficacy of dynamic graciloplasty for fecal incontinence. Dis Colon Rectum 45:809–818

    Article  Google Scholar 

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Correspondence to D. Mege.

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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 (2021). https://doi.org/10.1007/s10151-021-02421-y

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Keywords

  • Fecal incontinence
  • Sphincter defect
  • Dynamic graciloplasty