Dynamic myoplasty in growing dogs as a feasibility study for treatment of fecal incontinence.
The feasibility of skeletal muscle transposition and electrical stimulation (dynamic myoplasty) for treatment of fecal incontinence has been shown in adults. It might be attractive to use such a technique in pediatric patients. Therefore, the influence of growth on skeletal muscle transposition and stimulation was studied in five puppies. In each dog, two neosphincters were constructed around a Thiry-Vella loop by using a dissected sartorius muscle with the neurovascular supply intact. In each of these five puppies, one of these muscles was electrically stimulated during a mean of 19 weeks (one puppy died during the first postoperative week). Muscle biopsies showed an increase in the percentage type I, fatigue-resistant muscle fibers from 61 to 94 in electrically stimulated sartorius neosphincters, but also an increase from 57 to 67 percent in transposed nonstimulated sartorius muscles. The diameter of these type I fibers during growth increased 36% in eletrically stimulated sartorius neosphincters and 55% in nonstimulated sphincters. Function of the neosphincters was tested with the inflow of saline in the Thiry-Vella loop. It was shown that the stimulated neosphincters were capable of inhibiting flow (which corresponded to manometric pressure registrations), but the nonstimulated sphincters were unable to inhibit flow. The experiments were complicated by infection and necrosis around the implanted stimulators in four puppies (which required reimplantation). We conclude that a dynamic myoplasty for fecal incontinence is feasible in growing puppies but that the technique is unacceptable during rapid growth because of the risks of infection and dislocation of the implanted device.
Konsten
J
J
Department of Surgery, Maastricht University Hospital, The Netherlands.
Geerdes
B
B
Baeten
C G
CG
Heineman
E
E
Arends
J W
JW
Pette
D
D
Soeters
P B
PB
D001003:Anal Canal / Q000503:physiopathology / Q000601:surgery; D000818:Animals; D001706:Biopsy; D004285:Dogs; D004599:Electric Stimulation Therapy; D004567:Electrodes, Implanted; D005240:Feasibility Studies; D005242:Fecal Incontinence / Q000503:physiopathology / Q000601:surgery*; D006128:Growth / Q000502:physiology; D009119:Muscle Contraction / Q000502:physiology; D018482:Muscle, Skeletal / Q000473:pathology / Q000601:surgery*