title: Electrically stimulated gracilis neosphincter for end-stage fecal incontinence: the long-term outcome.
abstract: BACKGROUND
  Electrically stimulated gracilis neosphincter is an established treatment for patients with end-stage fecal incontinence. Few data, however, describe its long-term efficacy.
  
  
  OBJECTIVE
  This study aimed to assess the long-term functional outcome associated with this procedure.
  
  
  METHODS
  Patients who underwent gracilis neosphincter construction between1989 and 2001 were identified from a prospectively recorded database. Demographics and pretreatment anorectal physiologic data were available for all patients.
  
  
  METHODS
  This study was conducted at an academic colorectal unit in a tertiary center.
  
  
  METHODS
  Sixty patients (median age, 42 years; 46 females) with fecal incontinence and a Williams continence score ≥5 were recruited to the study. The causes of incontinence included obstetric injury (n = 22), anal surgery (n = 17), atresia (n = 7), idiopathic incontinence (n = 6), anorectal excision (n = 4), and ileoanal pouch incontinence (n = 4).
  
  
  METHODS
  The primary outcomes measured were the Williams continence score and the proportion of patients with a Williams score ≤3 who avoided permanent stoma formation.
  
  
  RESULTS
  Continence improved for the cohort postoperatively at 2 years (2(2-5); p < 0.001) but no significant difference was found between continence scores preoperatively and at 13 years (5(3-6); p = not significant). However, a sustained improvement at 13 years was noted for patients in the anal surgery (3(2-5);p < 0.001) and obstetric injury groups (4.5(3-6); p = 0.001). Twenty-six patients (43%) had a Williams score ≤3 and avoided permanent stoma after 13 years. Eighteen patients developed postoperative rectal evacuatory disorder; 10 of them required a conduit to facilitate colonic irrigation. Postoperative evacuatory disorder was more frequent in patients with a history of obstetric injury (p = 0.008).
  
  
  CONCLUSIONS
  This study was limited by the lack of bowel diaries and quality-of-life scores.
  
  
  CONCLUSIONS
  Gracilis neosphincter is associated with clinically significant and sustained symptom improvement in patients with end-stage fecal incontinence secondary to obstetric injury or anal surgery. These data support the continued use of this procedure in highly selected patients.
authors.affiliation: Academic Surgical Unit, National Centre for Bowel Research and Surgical Innovation, Barts Health NHS Trust, London, United Kingdom.
authors.forename: Derek J
authors.initials: DJ
authors.lastname: Boyle
authors.forename: Jamie
authors.initials: J
authors.lastname: Murphy
authors.forename: Alexander
authors.initials: A
authors.lastname: Hotouras
authors.forename: Marion E
authors.initials: ME
authors.lastname: Allison
authors.forename: Norman S
authors.initials: NS
authors.lastname: Williams
authors.forename: Christopher L
authors.initials: CL
authors.lastname: Chan
mesh_terms: D000328:Adult; D001003:Anal Canal / Q000601:surgery*; D015331:Cohort Studies; D003672:Defecation; D004599:Electric Stimulation Therapy; D004567:Electrodes, Implanted; D005242:Fecal Incontinence / Q000209:etiology / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000601:surgery; D020127:Recovery of Function; D013997:Time Factors; D016896:Treatment Outcome