STUDY PROTOCOLS AND FUNCTIONAL RESULTS IN 86 ELECTROSTIMULATED GRACILOPLASTIES

PURPOSE: This study analyzes different protocols adopted in 86 electro stimulated graciloplasties performed during the last eight years, comp aring functional and manometry results in 63 patients. METHODS: Electr ostimulated graciloplasties were performed to construct a neosphincter after surgical removal of the anorectum for cancer in 75 patients and to substitute the anal sphincter in 11 fully incontinent patients. An intermittent stimulation protocol, using external devices, was applie d in the first 68 patients, while long-term stimulation was carried ou t with implantable stimulators and intramuscular electrodes in the las t 18 patients. Sixty-three patients remaining under study were evaluat ed by questionnaires, continence scores, and manometry. RESULTS: In pa tients submitted to intermittent stimulation, continence was achieved in 71 percent of 42 ''neosphincters'' after rectal resection and in 33 percent of 3 incontinent patients. Adopting chronic stimulation, impl antable stimulators and intramuscular electrodes, continence reached 1 00 percent and 83 percent, respectively. Significant differences were also observed in resting and voluntary pressure values between the int ermittently and chronically stimulated patients. Incontinent patients showed after chronic stimulation significant increases in mean resting and maximum voluntary pressures: from 13.3 to 60.5 mmHg and from 32 t o 103 mmHg, respectively (P < 0.01). CONCLUSIONS: This study confirms the efficacy of chronic stimulation and the validity of a bilateral, ' 'one-time'' graciloplasty to reconstruct or substitute the anal sphinc ter.