Study protocols and functional results in 86 electrostimulated graciloplasties.
OBJECTIVE
This study analyzes different protocols adopted in 86 electrostimulated graciloplasties performed during the last eight years, comparing functional and manometry results in 63 patients.


METHODS
Electrostimulated graciloplasties were performed to construct a neosphincter after surgical removal of the anorectum for cancer in 75 patients and to substitute the anal sphincter in 11 fully incontinent patients. An intermittent stimulation protocol, using external devices, was applied in the first 68 patients, while long-term stimulation was carried out with implantable stimulators and intramuscular electrodes in the last 18 patients. Sixty-three patients remaining under study were evaluated by questionnaires, continence scores, and manometry.


RESULTS
In patients submitted to intermittent stimulation, continence was achieved in 71 percent of 42 "neosphincters" after rectal resection and in 33 percent of 3 incontinent patients. Adopting chronic stimulation, implantable stimulators and intramuscular electrodes, continence reached 100 percent and 83 percent, respectively. Significant differences were also observed in resting and voluntary pressure values between the intermittently and chronically stimulated patients. Incontinent patients showed after chronic stimulation significant increases in mean resting and maximum voluntary pressures: from 13.3 to 60.5 mmHg and from 32 to 103 mmHg, respectively (P < 0.01).


CONCLUSIONS
This study confirms the efficacy of chronic stimulation and the validity of a bilateral, "one-time" graciloplasty to reconstruct or substitute the anal sphincter.
Seccia
M
M
Section of Colorectal Surgery, University of Pisa, Italy.
Menconi
C
C
Balestri
R
R
Cavina
E
E
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002277:Carcinoma / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D002985:Clinical Protocols; D003131:Combined Modality Therapy; D003672:Defecation; D004599:Electric Stimulation Therapy / Q000295:instrumentation / Q000379:methods*; D004567:Electrodes, Implanted; D005242:Fecal Incontinence / Q000145:classification / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008365:Manometry; D008875:Middle Aged; D009132:Muscles / Q000637:transplantation*; D016737:Proctocolectomy, Restorative / Q000379:methods*; D012004:Rectal Neoplasms / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome