Long-term efficacy of dynamic graciloplasty for fecal incontinence.
OBJECTIVE
Patients with end-stage fecal incontinence in whom all standard medical and surgical treatment has failed or is not expected to be effective can be treated by dynamic graciloplasty. The aim of this study was to review the long-term efficacy data.


METHODS
Success was defined as a greater than 50 percent decrease in the frequency of incontinent episodes. Measured physiologic parameters included enema retention time and the difference in resting and squeezing pressures with and without stimulation. Measured quality-of-life parameters included the Medical Outcomes Study Short Form 36 Health Status Questionnaire, a Fecal Incontinence TyPE Specification, the Zung Self-Rating Depression Scale, the "state" portion of the State-Trait Anxiety Inventory, and the Visual Analog Scale, which were administered at baseline and through follow-up. Independent monitors collected data as part of a multicenter trial for patients who underwent dynamic graciloplasty from May 1993 to November 1999.


RESULTS
There were 129 patients entered in the study, 115 of whom met eligibility criteria and were included in the efficacy outcome analysis. Twenty-seven patients entered the study with a preexisting functioning stoma; the remaining 88 patients did not have a functioning stoma at the time of enrollment. Success was achieved in 62 percent of nonstoma patients at 12 months; these results were sustained at 18-month and 24-month follow-up assessments (55 and 56 percent, respectively). The success rate in the stoma patients increased from 37.5 percent (9 of 24 patients) at 12 months to 62 percent (13 of 21 patients) at 18 months and was 43 percent at 24 months (9 of 21 patients), which reflects the increased number of patients whose stomas were closed. Although the measured physiologic continence parameters generally improved, these changes did not correlate with continence outcome. The group of patients (stoma and nonstoma) who underwent dynamic graciloplasty showed statistically significant improvements in quality of life as measured by Medical Outcomes Study Short Form 36 physical function (P = 0.006) and social functioning (P = 0.02) assessment.


CONCLUSIONS
Dynamic graciloplasty was successful in the majority of patients with end-stage fecal incontinence. This result was usually achieved by 12 months after surgery in patients who did not have stomas and by 18 months in patients who had stomas at the time of dynamic graciloplasty surgery. These various improvements conferred by dynamic graciloplasty persisted during the two-year follow-up.
Wexner
Steven D
SD
Cleveland Clinic Florida, Weston, FL, USA.
Baeten
Cor
C
Bailey
Randolph
R
Bakka
Arne
A
Belin
Bruce
B
Belliveau
Paul
P
Berg
Eugen
E
Buie
W Donald
WD
Burnstein
Marcus
M
Christiansen
John
J
Coller
John
J
Galandiuk
Susan
S
Lange
J
J
Madoff
Robert
R
Matzel
Klaus E
KE
Påhlman
Lars
L
Parc
Rolland
R
Reilly
John
J
Seccia
Massimo
M
Thorson
Alan G
AG
Vernava
Anthony M
AM
D000293:Adolescent; D000328:Adult; D000368:Aged; D001003:Anal Canal / Q000601:surgery; D003625:Data Collection; D005242:Fecal Incontinence / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D009130:Muscle, Smooth / Q000637:transplantation*; D011788:Quality of Life; D012189:Retrospective Studies; D054047:Surgical Stomas; D016896:Treatment Outcome