Rectal augmentation and stimulated gracilis anal neosphincter - A new approach in the management of fecal urgency and incontinence

PURPOSE: The aim of this study was the development of a procedure which wou ld successfully treat selected patients presenting with incapacitating urge ncy and fecal incontinence. Some patients presenting with urgency and fecal incontinence, with an intact anorectum but deficient sphincter mechanism, have low rectal compliance. Management is problematic, because correction o f the sphincter defect does not abolish the incapacitating urgency caused b y rectal hypersensitivity. METHODS: This was a prospective study of three f emale patients with urgency and fecal incontinence who underwent combined r ectal augmentation using a segment of distal ileum and stimulated gracilis anal neosphincter. All patients had low rectal volumes and two exhibited a temporal relationship between high-amplitude (>60 mmHg) rectal pressure wav es and urgency on prolonged ambulatory anorectal manometry. RESULTS: Urgenc y was abolished and continence restored in all individuals. When the level of stimulation was not optimal or had been discontinued, patients experienc ed only passive incontinence with no urgency. Postoperative physiology reve aled elevated thresholds to rectal distention and a reduction in the number of high-amplitude rectal pressure waves in all cases. CONCLUSIONS: Combine d rectal augmentation with stimulated gracilis anal neosphincter may be of benefit to some patients with distressing urgency and fecal incontinence no t previously helped by current techniques.