Modified dynamic gracilis neosphincter for fecal incontinence: an analysis of functional outcome at a single institution

Background: We undertook a prospective longitudinal study of patients with end-stage fecal incontinence who were undergoing transposition of the gracilis muscle as a neo-anal sphincter with external low-frequency electrical stimulation of the nerve to the gracilis combined with biofeedback. Methods:...

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Main Authors:	Mat Hassan, Mohd. Zailani, Rathnayaka, M.M.G, Deen, K.I
Format:	Article
Language:	English
Published:	Springer 2010
Subjects:	RD Surgery
Online Access:	http://irep.iium.edu.my/11907/ http://irep.iium.edu.my/11907/ http://irep.iium.edu.my/11907/ http://irep.iium.edu.my/11907/1/Modified_Dynamic_Gracilis_Neosphincter_for_Fecal_Incontinence.pdf

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spelling	iium-119072012-02-03T02:39:26Z http://irep.iium.edu.my/11907/ Modified dynamic gracilis neosphincter for fecal incontinence: an analysis of functional outcome at a single institution Mat Hassan, Mohd. Zailani Rathnayaka, M.M.G Deen, K.I RD Surgery Background: We undertook a prospective longitudinal study of patients with end-stage fecal incontinence who were undergoing transposition of the gracilis muscle as a neo-anal sphincter with external low-frequency electrical stimulation of the nerve to the gracilis combined with biofeedback. Methods: A total of 31 patients (21 male, 10 female: median age: 22 years; range: 4-77 years) underwent this procedure for treatment of traumatic disruption (11 patients, 35%), congenital atresia (11 patients, 35%), iatrogenic injury (6-20%), and perineal sepsis (3 patients, 10%). The gracilis muscle was transposed at operation in an alpha or gamma configuration. Low-frequency (7 Hz) transcutaneous electrical stimulation commenced 2 weeks after operation and was continued for up to 12 weeks. Biofeedback therapy, which consisted of supervised neosphincter squeeze exercises, commenced simultaneously and continued for up to 28 weeks. Outcome was assessed by clinical examination, anal manometry, the Cleveland Clinic Florida continence score (CCFS), and the Rockwood quality of life scale (FIQL). Successful outcome was defined by improvement in clinical outcome, patient satisfaction, a positive result on anal manometry, and/or CCFS < 9, or FIQL ≥ 4. Results: At median follow-up of 67 months, overall improvement was seen in 22 (71%). Maximum resting pressure (MRP) and maximum squeeze pressure (MSP) improved significantly after operation [MRP pre versus post, mean (SD), cm water-13.8 (9.6) versus 20.9 (11.3); P = 0.01; and MSP 36.6 (22.4) versus 95.4 (71.2), P = 0.001]. In a subset of 18 patients who showed improvement after operation, the CCFS score (mean, SD) improved from 19.2 (3.4) to 5.2 (5.6); P = 0.0001. FIQL (mean, SD) showed significant improvement in all four domains in 14 patients who reported improvement since the year 2000. Conclusions: A modified dynamic gracilis neoanal sphincter for end-stage fecal incontinence helps restore and sustain continence with improvement in quality of life in the majority of patients. The procedure was most effective as augmentation in those who had suffered a traumatic injury, when compared with patients with congenital atresia and sepsis that had resulted in loss of the native anal sphincter. Springer 2010 Article PeerReviewed application/pdf en http://irep.iium.edu.my/11907/1/Modified_Dynamic_Gracilis_Neosphincter_for_Fecal_Incontinence.pdf Mat Hassan, Mohd. Zailani and Rathnayaka, M.M.G and Deen, K.I (2010) Modified dynamic gracilis neosphincter for fecal incontinence: an analysis of functional outcome at a single institution. World Journal of Surgery, 34 (7). pp. 1641-1647. ISSN 1432-2323 (O), 0364-2313 (P) http://www.springerlink.com/content/d03q9qn46781237j/ 10.1007/s00268-010-0489-1
repository_type	Digital Repository
institution_category	Local University
institution	International Islamic University Malaysia
building	IIUM Repository
collection	Online Access
language	English
topic	RD Surgery
spellingShingle	RD Surgery Mat Hassan, Mohd. Zailani Rathnayaka, M.M.G Deen, K.I Modified dynamic gracilis neosphincter for fecal incontinence: an analysis of functional outcome at a single institution
description	Background: We undertook a prospective longitudinal study of patients with end-stage fecal incontinence who were undergoing transposition of the gracilis muscle as a neo-anal sphincter with external low-frequency electrical stimulation of the nerve to the gracilis combined with biofeedback. Methods: A total of 31 patients (21 male, 10 female: median age: 22 years; range: 4-77 years) underwent this procedure for treatment of traumatic disruption (11 patients, 35%), congenital atresia (11 patients, 35%), iatrogenic injury (6-20%), and perineal sepsis (3 patients, 10%). The gracilis muscle was transposed at operation in an alpha or gamma configuration. Low-frequency (7 Hz) transcutaneous electrical stimulation commenced 2 weeks after operation and was continued for up to 12 weeks. Biofeedback therapy, which consisted of supervised neosphincter squeeze exercises, commenced simultaneously and continued for up to 28 weeks. Outcome was assessed by clinical examination, anal manometry, the Cleveland Clinic Florida continence score (CCFS), and the Rockwood quality of life scale (FIQL). Successful outcome was defined by improvement in clinical outcome, patient satisfaction, a positive result on anal manometry, and/or CCFS < 9, or FIQL ≥ 4. Results: At median follow-up of 67 months, overall improvement was seen in 22 (71%). Maximum resting pressure (MRP) and maximum squeeze pressure (MSP) improved significantly after operation [MRP pre versus post, mean (SD), cm water-13.8 (9.6) versus 20.9 (11.3); P = 0.01; and MSP 36.6 (22.4) versus 95.4 (71.2), P = 0.001]. In a subset of 18 patients who showed improvement after operation, the CCFS score (mean, SD) improved from 19.2 (3.4) to 5.2 (5.6); P = 0.0001. FIQL (mean, SD) showed significant improvement in all four domains in 14 patients who reported improvement since the year 2000. Conclusions: A modified dynamic gracilis neoanal sphincter for end-stage fecal incontinence helps restore and sustain continence with improvement in quality of life in the majority of patients. The procedure was most effective as augmentation in those who had suffered a traumatic injury, when compared with patients with congenital atresia and sepsis that had resulted in loss of the native anal sphincter.
format	Article
author	Mat Hassan, Mohd. Zailani Rathnayaka, M.M.G Deen, K.I
author_facet	Mat Hassan, Mohd. Zailani Rathnayaka, M.M.G Deen, K.I
author_sort	Mat Hassan, Mohd. Zailani
title	Modified dynamic gracilis neosphincter for fecal incontinence: an analysis of functional outcome at a single institution
title_short	Modified dynamic gracilis neosphincter for fecal incontinence: an analysis of functional outcome at a single institution
title_full	Modified dynamic gracilis neosphincter for fecal incontinence: an analysis of functional outcome at a single institution
title_fullStr	Modified dynamic gracilis neosphincter for fecal incontinence: an analysis of functional outcome at a single institution
title_full_unstemmed	Modified dynamic gracilis neosphincter for fecal incontinence: an analysis of functional outcome at a single institution
title_sort	modified dynamic gracilis neosphincter for fecal incontinence: an analysis of functional outcome at a single institution
publisher	Springer
publishDate	2010
url	http://irep.iium.edu.my/11907/ http://irep.iium.edu.my/11907/ http://irep.iium.edu.my/11907/ http://irep.iium.edu.my/11907/1/Modified_Dynamic_Gracilis_Neosphincter_for_Fecal_Incontinence.pdf
first_indexed	2023-09-18T20:21:10Z
last_indexed	2023-09-18T20:21:10Z
_version_	1777408116944535552

Modified dynamic gracilis neosphincter for fecal incontinence: an analysis of functional outcome at a single institution

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