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The Colorectal Development Unit: impact on functional outcome for the electrically stimulated gracilis neoanal
J R Saunders1, A A Darakhshan, A J P Eccersley
1Centre for Academic Surgery, Barts and The London, Queen Mary School of Medicine and Dentistry, London, UK. j.r.saunders@another.com
Insights
Establishing a Colorectal Development Unit (CDU) significantly improved outcomes for patients undergoing electrically stimulated gracilis neoanal sphincter (ESGN) surgery for fecal incontinence. The CDU approach led to better functional results and fewer complications.
Area of Science:
- Colorectal Surgery
- Gastroenterology
- Medical Device Technology
Background:
- End-stage fecal incontinence presents a significant challenge in patient management.
- The electrically stimulated gracilis neoanal sphincter (ESGN) is a surgical option for severe fecal incontinence.
- The establishment of specialized units can potentially optimize patient care and outcomes.
Purpose of the Study:
- To evaluate the impact of a dedicated Colorectal Development Unit (CDU) on functional outcomes and complication rates.
- To compare results of ESGN surgery performed within the CDU versus before its establishment.
Main Methods:
- Retrospective comparison of 53 patients who underwent ESGN formation within the CDU (1997-2003) and 65 patients who underwent the procedure pre-CDU (1988-1997).
- Patient groups were matched for age, sex, etiology, and follow-up duration.
- Functional outcome was defined as continence to solid and liquid stool.
Main Results:
- A good functional outcome (continence to solid and liquid stool) was achieved in 70% of CDU patients, a significant improvement from 45% in the pre-CDU group (P = 0.01).
- Technical complications leading to stimulator replacement decreased significantly from 25 to 3 (P < 0.001).
- Severe septic episodes were reduced from 21 to 4 (P = 0.003), with no significant change in postoperative evacuatory dysfunction.
Conclusions:
- The establishment of a Colorectal Development Unit (CDU) has led to significantly improved functional outcomes and reduced complications for patients undergoing ESGN surgery.
- Improvements are likely due to enhanced patient selection, more reliable equipment, and multidisciplinary team expertise.
- The CDU model represents a valuable advancement in managing end-stage fecal incontinence.
Objective:
A Colorectal Development Unit (CDU) was established to treat patients with end stage faecal incontinence with the electrically stimulated gracilis neoanal sphincter (ESGN). The aim of this study was to investigate the impact of the CDU on functional outcome and complications.
Methods:
From March 1997 to March 2003, 53 patients underwent ESGN formation. Results were compared with 65 patients undergoing ESGN surgery prior to the establishment of the unit (pre-CDU) between 1988 and 1997, which were similar with regard to age, sex, aetiology and follow-up.
Results:
Thirty-three (70%) CDU patients had a good functional outcome defined as continence to solid and liquid stool, a significant improvement when compared to the pre-CDU group, successful in 29 (45%) (P = 0.01). Episodes of technical complications leading to stimulator replacement were significantly reduced, from 25 to 3 over time (P < 0.001). Severe septic episodes were significantly reduced from 21 to four (P = 0.003) but there was no significant change in the incidence of postoperative evacuatory dysfunction.
Conclusion:
Since setting up a CDU, a successful outcome has been achieved in 33 (70%) of 47 patients undergoing ESGN surgery, which represents a significant improvement over time. This is probably related to improved patient assessment and selection, more reliable equipment and increased operative and peri-operative experience that come with a multidisciplinary team approach.
