title: Dynamic versus Adynamic Graciloplasty in Treatment of End-Stage Fecal Incontinence: Is the Implantation of the Pacemaker Really Necessary? 12-Month Follow-Up in a Clinical, Physiological, and Functional Study.
abstract: Purpose. The aim of the study is to compare functional results of end-stage fecal incontinence treatment with dynamic graciloplasty and adynamic graciloplasty augmented with transanal conditioning of the transposed muscle. Methods. A total of 20 patients were qualified for graciloplasty procedure due to end-stage fecal incontinence. 7 patients underwent dynamic graciloplasty (DGP), whereas 13 patients were treated with adynamic graciloplasty, with transanal stimulation in the postoperative period (AGP). Clinical, functional, and quality of life assessments were performed 3, 6, and 12 months after the procedures. Results. There were no intraoperative or early postoperative complications. The detachment of gracilis muscle tendon was observed in one patient in DGP group and two in AGP group. There was a significant improvement of Fecal Incontinence Quality of Life (FIQL) and Fecal Incontinence Severity Index (FISI) scores in both groups 12 months after procedure. Anorectal manometry showed improvement regarding basal and squeeze pressures in both groups, with significantly better squeeze pressures in AGP group. Conclusions. The functional effects in the DGP and AGP groups were similar. Significantly lower price of the procedure and avoidance of implant-related complication risk suggest the attractiveness of the AGP method augmented by transanal stimulation.
authors: Third Department of General Surgery, Jagiellonian University Medical College, Pradnicka Street 35-37, 31-202 Krakow, Poland.
authors: Piotr
authors: P
authors: Walega
authors: Third Department of General Surgery, Jagiellonian University Medical College, Pradnicka Street 35-37, 31-202 Krakow, Poland.
authors: Michal
authors: M
authors: Romaniszyn
authors: Gabriel Narutowicz Memorial Hospital, Pradnicka Street 35-37, 31-202 Krakow, Poland.
authors: Benita
authors: B
authors: Siarkiewicz
authors: Gabriel Narutowicz Memorial Hospital, Pradnicka Street 35-37, 31-202 Krakow, Poland.
authors: Dorota
authors: D
authors: Zelazny