title: Dynamic graciloplasty for anal atresia.
abstract: The aim of this study was to assess whether an electrically stimulated graciloplasty (dynamic graciloplasty) can achieve continence in nine patients with anal atresia (median age, 28 years; range, 18 to 40). As the first procedure, a gracilis muscle was transposed. Six weeks later, intramuscular electrodes were implanted and connected to a pulse generator. Eventually, the muscle was gradually trained, by electrical stimulation, to achieve fecal continence. Continence was obtained in five patients (55%). Manometry demonstrated an increase in mean anal pressure, from 36 mm Hg (without stimulation) to 52 mm Hg (with stimulation), after 8 weeks (mean increase, 16 mm Hg, [95% confidence interval, 8, 24 mm Hg; n = 9; P < .01). Failures resulted from a noncontracting distal part of the gracilis muscle (in three patients) and a nondistending rectum (in one patient). We conclude that dynamic graciloplasty can achieve continence in a substantial number of patients with thus-far untreatable incontinence after surgical correction for anal atresia.
authors.affiliation: Department of Surgery, Maastricht University Hospital, The Netherlands.
authors.forename: C G
authors.initials: CG
authors.lastname: Baeten
authors.forename: J
authors.initials: J
authors.lastname: Konsten
authors.forename: E
authors.initials: E
authors.lastname: Heineman
authors.forename: P B
authors.initials: PB
authors.lastname: Soeters
mesh_terms: D000328:Adult; D001003:Anal Canal / Q000601:surgery*; D001006:Anus, Imperforate / Q000150:complications / Q000601:surgery*; D003672:Defecation / Q000502:physiology; D004599:Electric Stimulation Therapy; D004567:Electrodes, Implanted; D005242:Fecal Incontinence / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008365:Manometry; D009119:Muscle Contraction / Q000502:physiology; D018482:Muscle, Skeletal / Q000637:transplantation*