Applied electrophysiology of transposed muscle stimulation: practical considerations and surgical experience on...

Dynamic Graciloplasty has demonstrated to be a reliable option in the treatment of end-stage Faecal Incontinence with stable results after long-term evaluation studies. Continence restoration varies from 40 to 65% depending on incontinence etiology and surgical experience. In spite of that mechanisms of chronic electrostimulation, necessary to obtain muscular fiber conversion and increase contractile resistance to a prolonged stimulation still remains unfriendly to many colorectal surgeons. On the basis of pioneering experience on this field we examine the main critical aspects of electrostimulation, ranging from neurovascular bundle preparation to electrodes insertion and stimulation protocol application. The experience in the last 36 dynamic graciloplasties performed for Faecal Incontinence treatment is presented. A long-term success rate of 75% was achieved. Key features for a good postoperative contractile response were identified in a careful gracilis mobilization, in a meticulous identification of nervous pedicle and in the prudent early p.o. stimulation. Fibers conversion was obtained after a 10-11 weeks of training period with on/off stimulation in the majority of patients and battery life was significantly prolonged with a meticulous search of the lowest intraoperative stimulation thresholds. Early failures demonstrated to be linked mainly to postoperative septic complications, while long-term results were significantly related to the efficacy of muscular recruitment and in preoperative phase, to a careful patients selection.