A NEW APPROACH TO DYNAMIC GRACILOPLASTY

The reestablishment of anal function by transposition of the gracilis muscle, combined with the implantation of electrodes and a neuromuscul ar stimulator (dynamic graciloplasty), has recently been developed. Wi th this method, the transposed muscle maintains contraction by electri cal stimulation to maintain neoanal pressure without fatigue. It is ne cessary to convert the fatigue-prone gracilis muscle to fatigue-resist ant muscle by long-term electrical stimulation (conditioning). In most patients receiving dynamic graciloplasty, the conditioning is accompl ished after the transposition. However, conditioning before gracilopla sty should reduce the risk of ischemia in the transposed muscle after the graciloplasty and improve the outcome. This new sequence of proced ures is described, in combination with J-pouch construction, in a pati ent who required abdominoperineal excision of the rectum for lower rec tal cancer. The graciloplasty was performed after conditioning of the gracilis muscle in situ; the conditioning did not cause the patient di scomfort and resulted in good anal function.