title: Neurostimulated levator augmentation--a new approach in restoring continence.
abstract: OBJECTIVE
  Restoration of continence remains a major challenge in patients after abdominoperineal rectal excision (APE) or with end-stage fecal incontinence. A new surgical technique, the neurostimulated levator augmentation, was introduced for pelvic floor augmentation using dynamic graciloplasty in order to restore anorectal angulation. The aim of this study was to assess feasibility and efficiency.
  
  
  METHODS
  From November 2009 to March 2014, n = 17 patients underwent neurostimulated levator augmentation (n = 10 after APE, n = 5 intractable idiopathic fecal incontinence, n = 2 traumatic anal amputation). Gracilis muscle was transposed through the obturator foramen into the pelvic cavity, positioned in a U-shaped sling behind the rectum, fixed to the contralateral os pubis to restore anorectal angulation, and then conditioned by neurostimulation. Questionnaires analyzing function and quality of life were administered.
  
  
  RESULTS
  For neurostimulated levator augmentation, four patients suffered from complications that needed operative intervention (n = 3 wound infection, n = 1 colon perforation); three pharmacological treatment and two complications needed no further invasive intervention. One patient died due to causes unrelated to the operation, and no complication required intensive care management. Fecal incontinence in patients with idiopathic incontinence improved significantly after surgery as well as incontinence episodes, urgency, and disease-specific quality of life through all dimensions. Generic quality of life was significantly better after surgery in all patients. After median follow-up of 17 months (2-45), all but one patient would undergo the procedure again.
  
  
  CONCLUSIONS
  Neurostimulated levator augmentation was feasible in all patients with acceptable morbidity. It may represent a new therapeutic option in selected patients with intractable fecal incontinence.
authors: Department of General, Gastrointestinal and Colorectal Surgery, Amalie-Sieveking Hospital, Haselkamp 33, 22359, Hamburg, Germany.
authors: Christoph
authors: C
authors: Isbert
authors: Nicolas
authors: N
authors: Schlegel
authors: Joachim
authors: J
authors: Reibetanz
authors: Katica
authors: K
authors: Krajinovic
authors: Karsten
authors: K
authors: Schmidt
authors: Christoph-Thomas
authors: CT
authors: Germer
authors: Mia
authors: M
authors: Kim
mesh_terms: D000328:Adult; D000368:Aged; D001003:Anal Canal / Q000601:surgery*; D002102:Cadaver; D004599:Electric Stimulation Therapy; D005240:Feasibility Studies; D005242:Fecal Incontinence / Q000209:etiology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000601:surgery*; D010502:Perineum / Q000601:surgery; D011446:Prospective Studies; D011788:Quality of Life; D012004:Rectal Neoplasms / Q000150:complications / Q000601:surgery; D012007:Rectum / Q000293:injuries / Q000294:innervation / Q000601:surgery*; D013524:Surgical Flaps