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Background In patients with intractable fecal incontinence, conventional treatment is not always successful. Dynamic graciloplasty (transposition of the gracilis muscle to the anus with the implantation of stimulating electrodes) was developed to provide such patients with functional neosphincters. We evaluated the clinical results of this new surgical approach and the effects on quality of life.
Methods We treated 52 patients with dynamic graciloplasty. The clinical results of treatment were evaluated in an interview, by anal manometry, and by enema testing. The degree of continence was scored. To assess quality of life, four questionnaires were administered (parts 1 and 2 of the Nottingham Health Profile, the State –Trait Anxiety Inventory, and the Self-rating Depression scale).
Results Among the 52 patients, 38 (73 percent) were continent after a median follow-up of 2.1 years. At 52 weeks the patients' condition had improved with respect to the median frequency of defecation (from five to two times per 24 hours, P<0.001), the median time defecation could be postponed (from 9 seconds to 19 minutes, P=0.012), and the median time an enema could be retained (from 0 to 180 seconds, P =0.005). Patients in whom the technique was successful became less anxious than those in whom it failed (P = 0.002) and improved with regard to effectiveness in their occupations, ability to perform tasks around the home, personal relationships, sexual function, and social life (P = 0.01). They also became less isolated socially (P = 0.05).
Conclusions Dynamic graciloplasty is a safe and reliable technique in patients with severe incontinence and may result in a better quality of life.
Source Information
From the Departments of General Surgery (C.G.M.I.B., B.P.G., E.M.M.A., E.H., J.K., P.B.S.), Planning (G.L.E.), Methodology and Statistics (A.D.M.K.), and Clinical Neurophysiology (F.S.), Maastricht University Hospital, Maastricht, the Netherlands.
Address reprint requests to Dr. Baeten at the Department of Surgery, Maastricht University Hospital, P. Debyelaan 25, P.O. Box 5800, 6202 AZ Maastricht, the Netherlands.
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