Rectal augmentation: short- and mid-term evaluation of a novel procedure for severe fecal urgency with associated incontinence.
BACKGROUND
Rectal augmentation (RA) with or without electrically stimulated gracilis neosphincter (ESGN) was developed to address the physiologic and anatomic abnormalities present in a subset of patients with incapacitating fecal urgency and associated urge fecal incontinence (UFI). This study evaluated the short- and medium-term clinical and physiologic results.


METHODS
Eleven patients with fecal urgency and UFI underwent RA, 6 with concomitant ESGN formation. Patients were evaluated preoperatively, and at a median of 12.5 and 54 months after surgery.


RESULTS
At 4.5 years, 7/11 patients had avoided stoma construction. Symptoms recurred leading to permanent stoma formation in 1 patient, whereas one other developed evacuatory difficulty with overflow incontinence. Median ability to defer defecation improved from seconds preoperatively to 10 minutes at 1 year (P = 0.0002), and 15 minutes at 4.5 years (P = 0.002). Median Wexner incontinence scores improved from 15 preoperatively to 3 at 1 year (P = 0.002), and 4 at 4.5 years (P = 0.02). At 1 year, 2 of the rectal sensory thresholds (DDV: P = 0.008; MTV: P = 0.008) and compliance were normalized (P = 0.008), whereas at 4.5 years, all sensation thresholds improved (FCS: P = 0.002; DDV: P = 0.002; MTV: P = 0.002), but changes in compliance were not significant.


CONCLUSIONS
RA with or without ESGN improved reported symptoms and normalized rectal sensation. Improvements were sustained in the medium term. The procedure had no associated morbidity or mortality, and should be considered in the surgical management of a select group of patients presenting with severe urgency and UFI.
Murphy
Jamie
J
Centre for Academic Surgery, Institute for Cell and Molecular Science, Barts and the London, Queen Mary's School of Medicine and Dentistry, University of London. jamie.murphy@qmul.ac.uk
Chan
Christopher L H
CL
Scott
S Mark
SM
Vasudevan
Subash P
SP
Lunniss
Peter J
PJ
Williams
Norman S
NS
D000328:Adult; D001003:Anal Canal / Q000502:physiology; D003672:Defecation; D013505:Digestive System Surgical Procedures / Q000379:methods; D004599:Electric Stimulation Therapy; D005242:Fecal Incontinence / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D012007:Rectum / Q000002:abnormalities / Q000294:innervation / Q000601:surgery*; D012008:Recurrence; D012684:Sensory Thresholds; D013997:Time Factors; D016896:Treatment Outcome