Analer Schließmuskelersatz mittels dynamischer Gracilisplastik – Ergebnisse der Anwendung an 50 Patienten

Abstract

During the period from 1992 to 1998, 50 patients underwent anal sphincter restoration by dynamic graciloplasty for primary (n = 26) or secondary (n = 6) total anorectal reconstruction (TAR) following abdominoperineal rectal resection (APR) or acquired (n = 9) or congenital (n = 9) fecal incontinence, respectively. Forty-seven patients were operated on by a single-stage procedure using a modified technique for the muscle wrap ("split sling"). Muscle fiber transformation by controlled stimulation was achieved at the beginning of the learning curve within 8 weeks and in the meantime within 4 weeks. Rectal injury (n = 10) turned out to be the most serious postoperative complication and was observed mainly in patients following TAR (n = 8). As the most prominent functional problem constipation in patients following TAR hampered the postoperative functional result; however, this was overcome by regular enemas. An improvement in the continence status was observed in 80% of the patients treated for fecal incontinence, and following APR 66% of the patients had acceptable results without a permanent colostomy.

Long‐term results of modified graciloplasty for sphincter replacement after rectal excision

“…Thus the patients reported in this study, not surprisingly, had a worse functional outcome. In a previous publication from this unit, patients with acquired faecal incontinence, achieved a Williams continence status of I–II in nearly 90% of cases [10]. In contrast, the present results and those of others show that total anorectal reconstruction is a compromise for the patients [13].…”

“…Muscle transformation was started in all patients at 14–41 days (median, 20 days) postoperatively. Based on our animal experiments [9,10], we have used the muscle fibre transformation protocol given in Table 2 since 1996. Continuous low frequency stimulation (5 Hz) is functionally efficient and very acceptable to the patient during the fibre transformation program.…”

Belgian experience with dynamic graciloplasty for faecal incontinence

“…Muscle training started a mean of 85 (median 48, range 11–875) days after graciloplasty. Forty‐five patients were trained as described by Baeten et al 6, 12 as described by Rosen et al 7, and alternative training strategies were used in three patients. Training duration varied between 4 and 16 weeks in most patients.…”

Schließmuskelprothese vs. Ersatzmuskelplastik bei hochgradiger Stuhlinkontinenz?

“…Gute Ergebnisse hinsichtlich der postoperativen Gewebeprotektivität und des funktionellen Outcomes in Relation zum technischen Aufwand werden mit der α-Split-sling-Konfiguration beschrieben, wobei ein optimaler intraoperativer Ruhedruck von 40-50 mmHg eingestellt werden sollte [62].…”