title: [Dynamic graciloplasty in the treatment of severe fecal incontinence--2 case reports].
abstract: Severe fecal incontinence is a serious problem not only for the patient whose quality of life is diminished, but also for the surgeon, who sometimes has difficulties how to manage all the aspects of this complicated condition. Conservative treatment is often ineffective, while operative sphincter repair is feasible only when anal sphincter is relatively functional and conserved. Dynamic graciloplasty is a method where functional anal neosphincter is constructed by transposing m. gracilis and wrapping it around the anal canal with subsequent implantation of electric neurostimulator and electrodes. Relatively good continence can be achieved with this technique, especially in-patients where all other therapeutic options failed. We present two patients, 25 and 21 years old, operated on our department, both suffered from severe fecal incontinence from the time they were born. They were interviewed, underwent a physical examination and evaluated by anal manometry, defecography and electromyography. Severe fecal incontinence was revealed (18 and 20, according to the Continence grading scale). In both cases, Gamma graciloplasty was performed. At first patient, implantation of the neurostimulator was performed 8 months after graciloplasty, while in second case, both graciloplasty and implantation of the electrodes with neurostimulator were performed at the same time. Postoperative recovery was uneventful in both cases. There was minor infection of the perineal wound in one patient. Electrostimulation training program was started on 9th postoperative day in both cases. Functional results were revealed by questionnaire and anal manometry. The quality of life was significantly improved in both cases, with good continence and psychological recovery. Anal manometry revealed increased anal contraction pressure comparing with preoperative basal and squeeze pressures. Dynamic graciloplasty is a relatively new; high specialized method in treatment of intractable, fecal incontinence. It is safe and reliable procedure in hands of an well-experienced surgeon, if well indicated and performed.
authors.affiliation: Institut za bolesti digestivnog sistema, KCS, Beograd.
authors.forename: G
authors.initials: G
authors.lastname: Barisić
authors.forename: Z
authors.initials: Z
authors.lastname: Krivokapić
authors.forename: A
authors.initials: A
authors.lastname: Marsavelska
authors.forename: M
authors.initials: M
authors.lastname: Popović
authors.forename: D
authors.initials: D
authors.lastname: Saranović
mesh_terms: D000328:Adult; D001003:Anal Canal / Q000601:surgery*; D004599:Electric Stimulation Therapy; D005242:Fecal Incontinence / Q000601:surgery*; D006801:Humans; D008297:Male; D018482:Muscle, Skeletal / Q000637:transplantation*