Restoration of fecal continence with chronic electrostimulation of gracilis muscle 17 years after a Pickrell's operation

A 27-year-old woman who had undergone a Pickrell's operation at the age of 10 years, was observed for severe incontinence to solid and liquid stools. Physical examination and physiological tests revealed poor resting anal ton e but a very good response of the transposed gracilis to percutaneous elect rostimulation, which showed that the gracilis ability to contract was maint ained in spite of 17 years of only occasional and unplanned muscular activi ty. Examination also demonstrated that the muscle had followed body growth during the patient's development. Restoration of continence by continuous e lectrostimulation of the gracilis muscle was then planned. To allow muscula r resistance to this stimulation a fast-to-slow twitch fiber conversion was first obtained by low-frequency electrostimulation. A subcutaneous abdomin al implant of a pulse generator connected to the gracilis by intramuscular platinum-iridium electrodes was carried out. After a period of muscular tra ining, fiber conversion was achieved, and continuous electrostimulation led to complete restoration of continence with stable results at the 36 month follow-up evaluation. This case demonstrates that even such a long period o f muscular inactivity does not affect the possibility of recovering a faile d Pickrell's operation using electrostimulation. This easy and safe procedu re can be applied to all previously failed graciloplasties provided that mu scle contractility is maintained.