The Colorectal Development Unit: impact on functional outcome for the electrically stimulated gracilis neoanal sphincter.
OBJECTIVE
A Colorectal Development Unit (CDU) was established to treat patients with end stage faecal incontinence with the electrically stimulated gracilis neoanal sphincter (ESGN). The aim of this study was to investigate the impact of the CDU on functional outcome and complications.


METHODS
From March 1997 to March 2003, 53 patients underwent ESGN formation. Results were compared with 65 patients undergoing ESGN surgery prior to the establishment of the unit (pre-CDU) between 1988 and 1997, which were similar with regard to age, sex, aetiology and follow-up.


RESULTS
Thirty-three (70%) CDU patients had a good functional outcome defined as continence to solid and liquid stool, a significant improvement when compared to the pre-CDU group, successful in 29 (45%) (P = 0.01). Episodes of technical complications leading to stimulator replacement were significantly reduced, from 25 to 3 over time (P < 0.001). Severe septic episodes were significantly reduced from 21 to four (P = 0.003) but there was no significant change in the incidence of postoperative evacuatory dysfunction.


CONCLUSIONS
Since setting up a CDU, a successful outcome has been achieved in 33 (70%) of 47 patients undergoing ESGN surgery, which represents a significant improvement over time. This is probably related to improved patient assessment and selection, more reliable equipment and increased operative and peri-operative experience that come with a multidisciplinary team approach.
Saunders
J R
JR
Centre for Academic Surgery, Barts and The London, Queen Mary School of Medicine and Dentistry, London, UK. j.r.saunders@another.com
Darakhshan
A A
AA
Eccersley
A J P
AJ
Lee
J E
JE
Allison
M E
ME
Lunniss
P J
PJ
Williams
N S
NS
D000293:Adolescent; D000328:Adult; D000368:Aged; D001003:Anal Canal / Q000503:physiopathology* / Q000601:surgery; D003082:Colectomy / Q000009:adverse effects; D004599:Electric Stimulation Therapy / Q000379:methods*; D005242:Fecal Incontinence / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012002:Rectal Diseases / Q000601:surgery; D012189:Retrospective Studies; D013503:Surgery Department, Hospital; D016896:Treatment Outcome