Unstimulated graciloplasty in traumatic faecal incontinence

Eccersley, A. J. P.; Lunniss, Peter J.; Williams, Norman S.

doi:10.1046/j.1365-2168.1999.01159.x

Cited by 11 publications

(4 citation statements)

References 5 publications

(6 reference statements)

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“…Eccersley et al . [ 24 ] reported that two-thirds of patients had improvement in continence with half of the patients experiencing good function. They concluded that these results were comparable to the results of their stimulated counterparts.…”

Section: Discussionmentioning

confidence: 99%

Gracilis muscle transposition as a workhorse flap for anal incontinence: Quality of life and functional outcome in adults

Kalra

Sharma

Shende

2016

Indian J Plast Surg

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Background/Purpose:Anal incontinence is one of the most psychologically and socially debilitating conditions in an otherwise healthy individual. It can lead to social isolation, loss of self-esteem, self-confidence and depression. This study is devoted to the problem of anal incontinence in the adult patients. The aim of our study is to analyse the results of gracilis muscle transposition for anal incontinence and improvement in quality of life (QOL) of patients.Materials and Methods:This was a retrospective study. A total of 18 patients with complaint of anal incontinence were enrolled in this study. All patients were treated with gracilis muscle transposition.Results:All patients are continent, and there is an improvement in their QOL.Conclusion:Gracilis muscle transposition is a good option for patients of anal incontinence who are not treated by non-surgical means.

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Section: Discussionmentioning

confidence: 99%

Gracilis muscle transposition as a workhorse flap for anal incontinence: Quality of life and functional outcome in adults

Kalra

Sharma

Shende

2016

Indian J Plast Surg

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“…In contrast, Yoshioka and Keighley 15 reported poor results in 6 patients who underwent graciloplasty, all of whom required a colostomy and 5 of whom had a septic complication. Eccersley et al 16 reported that two thirds of patients had improvement in continence with half of the patients experiencing good function. They concluded that these results were comparable to the results of their stimulated counterparts.…”

Section: Unstimulated Graciloplastymentioning

confidence: 99%

Muscle Transposition: Does It Still Have a Role?

Susan

Wexner

2005

Clinics in Colon and Rectal Surgery

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Since the early 1900s, skeletal muscle transpositions have been employed for complicated cases of fecal incontinence to augment or replace the anal sphincter. Multiple techniques have evolved that vary with the type and configuration of muscle used in the reconstruction. Transposition of the gluteus maximus muscle was popular in the early stages of development but was replaced by techniques involving transposition of the gracilis muscle. Within the past 16 years, electrical stimulators have been applied to the transposed muscle flaps to create a dynamic reconstruction improving the efficacy of these neosphincters over their static counterparts. However, the stimulated versions are technically demanding with a high rate of morbidity secondary to complications of the multiple components and variations in technique. The stimulator used in this procedure has been removed from the US market, although it is still available in other countries. Currently in the United States, gracilis transposition is still employed in the absence of an electrical stimulator as an adjunct to the artificial bowel sphincter (Acticon Neosphincter TM , American Medical Systems, Minnetonka, MN), such as in cases of severe muscle loss and congenital atresia. In European countries, the stimulated graciloplasty continues to evolve, leading to expansion of its use in total anorectal reconstruction for anal atresia and after abdominoperineal resection. KEYWORDS: Fecal incontinence, muscle transposition, graciloplasty, gluteoplasty, neosphincter constructionObjectives: Upon completion of this article, the reader should be able to: (1) list current therapeutic options for failed overlapping sphincteroplasty; and (2) evaluate the results of each of these procedures.Patients with severe fecal incontinence unresponsive to conservative measures can be divided into two broad categories of surgical approach. The first group includes those patients with an identifiable anatomic sphincter defect who can expect a 40 to 60% long-term surgical success rate with overlapping sphincteroplasty.1 The absence of pudendal neuropathy yields the best outcome in these patients. 2 The second group includes those patients with extensive sphincter damage, muscle loss, or pudendal neuropathy not amenable to direct sphincter repair. With the widespread prevalence of fecal incontinence and development of newer surgical techniques, the patient with severe fecal incontinence is seldom obligated to a permanent stoma. Neosphincter

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“…[19] first explored the use of the unstimulated gracilis muscle in sphincter reconstruction. Only a third of patients undergoing an unstimulated graciloplasty achieved good function [20] since the muscle fatigued and could not sustain a contraction to maintain continence. It was not until the 1980s that chronic electrical stimulation of muscle was exploited [21,22], transforming fast twitch muscle to slow twitch muscle, enabling progression to the ESGN [18], or as it is also known, the dynamic graciloplasty [23].…”

Section: Introductionmentioning

confidence: 99%