Surgical results and functional outcome after total anorectal reconstruction by double graciloplasty supported by external-source electrostimulation and/or implantable pulse generators: an 8-year experience

Violi, Vincenzo; Boselli, Adamo S.; Bernardinis, M. De; Costi, Roberta; Nervi, G.; Bertelè, A.; Franzè, A.; Roncoroni, L

doi:10.1007/s00384-003-0528-6

Cited by 12 publications

(9 citation statements)

References 26 publications

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“…Thus, the acquisition of technical knowledge seems insufficient in light of the great efforts. 22 The small number of patients per center raises another question: to what extent is the learning curve for ABS and DGP related to the outcome? Whereas some authors relying on their own results claim that there is no learning curve dependence, 21 most studies reveal the opposite.…”

Section: Discussionmentioning

confidence: 99%

“…48 Our evaluation of DGP and ABS was also made difficult by the different techniques used in study centers around the world (including single or double graciloplasty, different neosphincter configurations, electrode placement, and the presence or absence of a preoperative stoma), different populations and primary pathology, different primary and secondary a norectal reconstruction, different follow-up periods and assessment times, the use of additional measures such as irrigation or constipating agents to obtain continence, and most of all, different methods of evaluation. 22 Despite the subjective obstacles, attention should be paid to objective difficulties in neosphincter surgery for fecal incontinence. First, it should be noted that DGP and ABS are still performed only sporadically around the world, because of the wide range of strict exclusion criteria and availability of these surgical options exclusively in large coloproctological centers.…”

Section: Discussionmentioning

confidence: 99%

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Neosphincter Surgery for Fecal Incontinence: A Critical and Unbiased Review of the Relevant Literature

2006

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Up until about 15 years ago the only realistic option for end-stage fecal incontinence was the creation of a permanent stoma. There have since been several developments. Dynamic graciloplasty (DGP) and artificial bowel sphincter (ABS) are well-established surgical techniques, which offer the patient a chance for continence restoration and improved quality of life; however, they are unfortunately associated with high morbidity and low success rates. Several trials have been done in an attempt to clarify the advantages and disadvantages of these methods and define their place in the second-line treatment of severe, refractory fecal incontinence. This review presents a critical and unbiased overview of the current status of neosphincter surgery according to the available data in the world literature.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Neosphincter Surgery for Fecal Incontinence: A Critical and Unbiased Review of the Relevant Literature

2006

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“…Graciloplasty offers theoretically a very good tool for the treatment of the end-stage fecal incontinence, although results are still suboptimal and depend on series the overall success rates are between 50% and 70% [3][4][5]. Neither the reasons for this significant number of failures nor the methods to avoid them are currently known.…”

Section: Introductionmentioning

confidence: 91%

Non-invasive Assessment of the Gracilis Muscle by Means of Surface Electromyography Electrode Arrays

Bottin

Cescon

Nowakowski

et al. 2006

Journal of Surgical Research

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“…71 Despite the high complication rates, many patients may ultimately achieve satisfactory functional outcomes. 72 A third described option to enhance function after APR is through the use of the artificial bowel sphincter (ABS). The ABS consists of a subcutaneous cuff surrounding the anus and a pump in the labial or scrotal area.…”

Section: Maintaining Intestinal Continuity After Aprmentioning

confidence: 99%

Sphincter-Sparing Surgery in Patients with Low-Lying Rectal Cancer: Techniques, Oncologic Outcomes, and Functional Results

Bordeianou

Maguire

Alavi

et al. 2014

Journal of Gastrointestinal Surgery

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Background Rectal cancer management has evolved into a complex multimodality approach with survival, local recurrence, and quality of life parameters being the relevant endpoints. Surgical treatment for low rectal cancer has changed dramatically over the past 100 years. Discussion Abdominoperineal resection, once the standard of care for all rectal cancers, has become much less frequently utilized as surgeons devise and test new techniques for preserving the sphincters, maintaining continuity, and performing oncologically sound ultra-low anterior or local resections. Progress in rectal cancer surgery has been driven by improved understanding of the anatomy and pathophysiology of the disease, innovative surgical technique, improved technology, multimodality approaches, and increased appreciation of the patient's quality of life. The patient with a low rectal cancer, once almost universally destined for impotence and a colostomy, now has the real potential for improved survival, avoidance of a permanent stoma, and preservation of the normal route of defecation.Keywords Rectal cancer . Sphincter preservation . Total mesorectal excision . Anterior resection . Intersphincteric resection . Local excision rectal cancer Historical BackgroundThe modern era of rectal cancer surgery began with the description of the abdominoperineal resection (APR) by Miles in 1908. Prior perineal and sacral approaches (e.g., Kraske approach) to rectal cancer resection produced high rates of complications, cancer recurrence, poor quality of life (QOL), and poor overall survival. Miles' operation reflected greater understanding of the natural history of rectal cancer that was based on postmortem examination of his patients after perineal resection. He observed cancerous implants in the pelvic peritoneum, mesorectum, and affected nodes of the left common iliac bifurcation. These findings led him to develop a "cylindrical concept" of the spread of rectal cancer to upward, downward, and lateral zones. 1 The original operation included resection of the rectum, sigmoid, mesorectum, nodes of the iliac bifurcation, and a perineal component to include the anus and levator ani muscles. Postoperative mortality was high initially, but local recurrence decreased

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Surgical results and functional outcome after total anorectal reconstruction by double graciloplasty supported by external-source electrostimulation and/or implantable pulse generators: an 8-year experience

Abstract: Despite marked morbidity the high rate of good results, which improved over time, suggests that total anorectal reconstruction is worth being performed as part of abdominoperineal resection in well-selected patients with a strong motivation to avoid a permanent colostomy.

Cited by 12 publications

References 26 publications

Neosphincter Surgery for Fecal Incontinence: A Critical and Unbiased Review of the Relevant Literature

Neosphincter Surgery for Fecal Incontinence: A Critical and Unbiased Review of the Relevant Literature

Non-invasive Assessment of the Gracilis Muscle by Means of Surface Electromyography Electrode Arrays

Sphincter-Sparing Surgery in Patients with Low-Lying Rectal Cancer: Techniques, Oncologic Outcomes, and Functional Results

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