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Desarrollo de un esfínter neoanal estimulado eléctricamente
N S Williams1, J Patel, B D George
1Surgical Unit, Royal London Hospital, Whitechapel, UK.
Lancet (London, England)
|November 9, 1991
Resumen
Este estudio mejoró las técnicas quirúrgicas para la incontinencia fecal mediante la modificación de la transposición del músculo gracilis y la estimulación eléctrica, restaurando con éxito la continencia en pacientes y ofreciendo una alternativa a los estomas permanentes.
Área de la Ciencia:
- Innovación quirúrgica en cirugía.
- La cirugía reconstructiva es una cirugía reconstructiva.
- Ingeniería biomédica de la ingeniería biomédica.
Sus antecedentes:
- La creación quirúrgica de un esfínter neoanal utilizando el músculo gracilis transpuesto ha enfrentado desafíos debido a la fatiga muscular.
- Los intentos anteriores de conversión muscular a un tipo resistente a la fatiga dieron resultados inconsistentes.
Objetivo del estudio:
- Para describir modificaciones en la técnica del esfínter neoanal utilizando un músculo gracilis transpuesto estimulado eléctricamente.
- Para mejorar los resultados funcionales a largo plazo en pacientes con incontinencia fecal.
Principales métodos:
- Músculo gracilis traspuesto con un estimulador totalmente implantado para convertir el músculo de contracción rápida en el de contracción lenta.
- Incorpora retraso vascular, estimulación nerviosa directa y estimulación intermitente de mayor frecuencia.
- Aplicado a 20 pacientes con esfínteres anales deficientes y 12 con ausencia/excisión anorectal.
Principales resultados:
- La técnica modificada, que incorpora 2-4 modificaciones específicas, dio como resultado un número significativamente menor de fallas en comparación con los métodos anteriores (modificaciones 0-1).
- Continencia restaurada en pacientes con incontinencia fecal severa.
Conclusiones:
- La técnica mejorada del esfínter neoanal ofrece una solución viable para la incontinencia fecal, evitando potencialmente la necesidad de un estoma permanente.
- Otras modificaciones mejoran significativamente la tasa de éxito de la transposición muscular para la reconstrucción del esfínter.
Videos de Conceptos Relacionados
01:41Action Potentials
Overview
01:09Synaptic Signaling
Neurons communicate at synapses, or junctions, to excite or inhibit the activity of other neurons or target cells, such as muscles. Synapses may be chemical or electrical.
Most synapses are chemical, meaning an electrical impulse or action potential spurs the release of chemical messengers called neurotransmitters. The neuron sending the signal is called the presynaptic neuron, and the neuron receiving the signal is the postsynaptic neuron.
The presynaptic neuron fires an action potential that...
Most synapses are chemical, meaning an electrical impulse or action potential spurs the release of chemical messengers called neurotransmitters. The neuron sending the signal is called the presynaptic neuron, and the neuron receiving the signal is the postsynaptic neuron.
The presynaptic neuron fires an action potential that...
01:14Action Potential
Neurons communicate by firing action potentials—the electrochemical signal that is propagated along the axon. The signal results in the release of neurotransmitters at axon terminals, thereby transmitting information to the nervous system. An action potential is a specific "all-or-none" change in membrane potential that results in a rapid spike in voltage.
Membrane potential in neurons
Neurons typically have a resting membrane potential of about -70 millivolts (mV). When they receive...
Membrane potential in neurons
Neurons typically have a resting membrane potential of about -70 millivolts (mV). When they receive...
01:28Electrical Synapses
Electrical synapses found in all nervous systems play important and unique roles. In these synapses, the presynaptic and postsynaptic membranes are very close together (3.5 nm) and are actually physically connected by channel proteins forming gap junctions.
Gap junctions allow the current to pass directly from one cell to the next. In contrast, in the chemical synapse, the neurotransmitters carry the information through the synaptic cleft from one neuron to the next. They consist of two...
Gap junctions allow the current to pass directly from one cell to the next. In contrast, in the chemical synapse, the neurotransmitters carry the information through the synaptic cleft from one neuron to the next. They consist of two...
01:14Action Potential
Neurons communicate by firing action potentials—the electrochemical signal that is propagated along the axon. The signal results in the release of neurotransmitters at axon terminals, thereby transmitting information to the nervous system. An action potential is a specific "all-or-none" change in membrane potential that results in a rapid spike in voltage.
Membrane potential in neurons
Neurons typically have a resting membrane potential of about -70 millivolts (mV). When they receive...
Membrane potential in neurons
Neurons typically have a resting membrane potential of about -70 millivolts (mV). When they receive...
01:28Neuronal Communication
Neurons, the fundamental units of the brain and nervous system, communicate through complex electrochemical signals that underpin all cognitive and bodily functions. This communication is primarily facilitated by a process involving the generation and propagation of an action potential along the axon of the neuron. When the internal electrical charge of a neuron surpasses a certain threshold, an action potential is triggered. This rapid change in voltage travels swiftly along the axon to the...