Safety and efficacy of dynamic muscle plasty for anal incontinence: Lessons from a prospective, multicenter trial

Background & Aims: Dynamic muscle plasty has been advocated as therapy for refractory fecal incontinence and for anorectal reconstruction to avoid col ostomy after abdominoperineal resection, This study evaluates the results o f a multicenter experience with dynamic muscle plasty in the treatment of f ecal incontinence and total anal reconstruction. Methods: One hundred thirt y-nine patients were enrolled at 12 centers between June 1992 and November 1994 and followed up through June 1996. Intramuscular leads and neurostimul ators were implanted to stimulate transposed gracilis or gluteus muscle. Su ccess was defined as 70% reduction in solid stool incontinence for patients with baseline incontinence and zero incontinence to solid stool for patien ts with baseline stomas and for patients undergoing total anal reconstructi on. Results: Overall, 85 of 128 graciloplasty patients (66%) achieved and m aintained a successful outcome over the follow-up period. By etiology, thes e proportions were 71%, 50%, and 66% for patients with acquired fecal incon tinence, congenital incontinence, and total anal reconstruction, respective ly. One third of graciloplasty patients experienced a major wound complicat ion, with therapy failing in 41%, Experienced centers had better outcomes a nd lower complication rates than inexperienced centers. Of the 11 gluteopla sty patients, 5 (45%) achieved and maintained a successful outcome. Conclus ions: Dynamic graciloplasty may be an effective procedure for patients with refractory, end-stage fecal incontinence as well as for patients who requi re anorectal excision for low-lying malignancy. However, the procedure has significant morbidity that can lead to functional failure. Outcome after dy namic graciloplasty appeals to correlate with surgical experience, In contr ast to graciloplasty, the use of dynamic gluteoplasty should be limited to investigational purposes.