Rectal augmentation and stimulated gracilis anal neosphincter: a new approach in the management of fecal urgency and incontinence.
OBJECTIVE
The aim of this study was the development of a procedure which would successfully treat selected patients presenting with incapacitating urgency and fecal incontinence. Some patients presenting with urgency and fecal incontinence, with an intact anorectum but deficient sphincter mechanism, have low rectal compliance. Management is problematic, because correction of the sphincter defect does not abolish the incapacitating urgency caused by rectal hypersensitivity.


METHODS
This was a prospective study of three female patients with urgency and fecal incontinence who underwent combined rectal augmentation using a segment of distal ileum and stimulated gracilis anal neosphincter. All patients had low rectal volumes and two exhibited a temporal relationship between high-amplitude (>60 mmHg) rectal pressure waves and urgency on prolonged ambulatory anorectal manometry.


RESULTS
Urgency was abolished and continence restored in all individuals. When the level of stimulation was not optimal or had been discontinued, patients experienced only passive incontinence with no urgency. Postoperative physiology revealed elevated thresholds to rectal distention and a reduction in the number of high-amplitude rectal pressure waves in all cases.


CONCLUSIONS
Combined rectal augmentation with stimulated gracilis anal neosphincter may be of benefit to some patients with distressing urgency and fecal incontinence not previously helped by current techniques.
Academic Department of Surgery, St. Bartholomew's and The Royal London School of Medicine and Dentistry, The Royal London Hospital, United Kingdom.
N S
NS
Williams
O A
OA
Ogunbiyi
S M
SM
Scott
O
O
Fajobi
P J
PJ
Lunniss
D000328:Adult; D001003:Anal Canal / Q000503:physiopathology / Q000601:surgery*; D013505:Digestive System Surgical Procedures / Q000379:methods; D004599:Electric Stimulation Therapy; D005242:Fecal Incontinence / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D006801:Humans; D007082:Ileum / Q000601:surgery; D008365:Manometry; D008875:Middle Aged; D012007:Rectum / Q000503:physiopathology / Q000601:surgery*