FOLLOW-UP OF ANAL DYNAMIC GRACILOPLASTY FOR FECAL CONTINENCE

The feasibility of anal dynamic graciloplasty (transposition of the gr acilis muscle and subsequent implantation of a stimulation device) to restore continence, was assessed in a case-control study of 26 patient s with severe fecal incontinence. It was shown that anal dynamic graci loplasty is capable of achieving the sphincter tone of healthy persons , as stimulated graciloplasty increased anal pressure from 46 mmHg wit hout stimulation to 65 mmHg with stimulation (mean increase 19 mmHg; 9 5% confidence interval 13, 25; n = 25; p < 0.01). Time to retain a 250 -ml phosphate enema increased from 52 seconds before to 204 seconds af ter 8 weeks of electrical stimulation (mean increase 151 seconds; 95% confidence interval 61, 241; n = 25; p < 0.01). Complete fecal contine nce was achieved in 17 patients (65%); two of these patients developed a wound infection, but one of the two realized continence without sti mulation and the other patient became continent after reimplantation. Three other patients improved after anal dynamic graciloplasty, but in fection necessitated removal of the stimulation device. One patient de veloped a fistula. Failures were encountered in five patients. Althoug h our long-term follow-up results suggest a learning curve, it is conc luded that electrical stimulation improves the results of conventional graciloplasty and avoids construction of a colostomy.