title: Third-party prospective evaluation of patient outcomes after dynamic graciloplasty.
abstract: BACKGROUND
  Dynamic graciloplasty (DGP) is a complex procedure designed to improve bowel function in patients with end-stage faecal incontinence. Outcomes of DGP were examined in comparison with stoma formation or continued medical management.
  
  
  METHODS
  This third-party evaluation comprised a prospective case-comparison study of patient-based and clinical outcomes at a London hospital. Forty-nine patients who underwent DGP during 5 years from 1997 were compared with 87 patients with similar bowel disorders who did not undergo DGP. Outcome measures were quality of life (QoL), symptoms, anxiety and depression.
  
  
  RESULTS
  At 2 years after surgery, bowel-related QoL and continence had improved by more than 20 per cent compared with the preoperative status for two-thirds of patients who had DGP (P < 0.001). Two-thirds were continent all or most of the time, although one-third experienced disordered bowel evacuation. Large deteriorations on the Nottingham Health Profile pain score occurred in 11 of 34 patients who had DGP, compared with seven of 57 patients in comparison groups (P = 0.027). Patients in comparison groups experienced no significant changes in measured outcomes over the 2 years of follow-up.
  
  
  CONCLUSIONS
  Although DGP is associated with a high level of morbidity, it deserves consideration as an alternative to life with severe and refractory faecal incontinence or stoma formation in people in whom conventional treatments have failed.
authors.affiliation: International Centre for Circulatory Health, Imperial College at St Mary's, London, UK. t.tillin@imperial.ac.uk
authors.forename: T
authors.initials: T
authors.lastname: Tillin
authors.forename: K
authors.initials: K
authors.lastname: Gannon
authors.forename: R A
authors.initials: RA
authors.lastname: Feldman
authors.forename: N S
authors.initials: NS
authors.lastname: Williams
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001003:Anal Canal / Q000601:surgery*; D002908:Chronic Disease; D003125:Colostomy; D005242:Fecal Incontinence / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011788:Quality of Life; D013315:Stress, Psychological / Q000209:etiology; D016896:Treatment Outcome