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Stimulated gracilis neosphincter--not as good as previously thought. Report of four cases
1University Department of Surgery, Queen Elizabeth Hospital, Birmingham, United Kingdom.
Purpose:
We report the outcome of four patients who had stimulated gracilis neosphincter for fecal incontinence to highlight functional problems, particularly in patients with impaired rectal evacuation.
Methods:
The gracilis neosphincter operation consisted of a three-stage procedure in four patients with intractable incontinence, three of whom had had a pelvic floor repair.
Results:
Despite successful muscle transposition and nerve stimulation, only one of four patients has a functioning neosphincter. One patient could not tolerate stimulation, and two were unable to evacuate the rectum. All three now have stomas, and even the functioning neosphincter patient requires regular bisacodyl (Dulcolax; CIBA Consumer Pharmaceuticals, Woodbridge, NJ) suppositories to achieve evacuation.
Conclusion:
The neosphincter is a successful sphincter but has no role for patients who cannot evacuate from the rectum.
