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Study protocols and functional results in 86 electrostimulated graciloplasties
M Seccia1, C Menconi, R Balestri
1Section of Colorectal Surgery, University of Pisa, Italy.
Diseases of the Colon and Rectum
|September 1, 1994
Summary
Chronic stimulation via implantable devices significantly improves continence and pressure in patients undergoing graciloplasty for anal sphincter reconstruction or substitution. This method is highly effective for fecal incontinence and post-cancer surgery.
Area of Science:
- Colorectal Surgery
- Pelvic Floor Reconstruction
- Bioengineering
Background:
- Graciloplasty, a surgical technique using the gracilis muscle, is employed for anal sphincter reconstruction or substitution.
- Electrostimulation enhances graciloplasty function, but optimal protocols require investigation.
Purpose of the Study:
- To compare functional and manometric outcomes of different electrostimulated graciloplasty protocols.
- To evaluate the efficacy of intermittent versus chronic stimulation in patients undergoing neosphincter construction or anal sphincter substitution.
Main Methods:
- Analysis of 86 electrostimulated graciloplasties over eight years, with 63 patients evaluated.
- Comparison of intermittent external stimulation (n=68) versus chronic implantable stimulation with intramuscular electrodes (n=18).
- Assessment using questionnaires, continence scores, and anorectal manometry.
Main Results:
- Chronic stimulation achieved 100% continence in neosphincter patients and 83% in incontinent patients, significantly outperforming intermittent stimulation (71% and 33%, respectively).
- Chronically stimulated patients demonstrated significant increases in resting and voluntary anal pressures (e.g., resting pressure from 13.3 to 60.5 mmHg).
- Manometric improvements were significantly greater with chronic stimulation compared to intermittent protocols.
Conclusions:
- Chronic electrostimulation with implantable devices is highly effective for graciloplasty.
- Bilateral, one-time graciloplasty combined with chronic stimulation offers a valid solution for anal sphincter reconstruction and fecal incontinence management.