title: Two different gracilis loops in graciloplasty of congenital fecal incontinence: comparison of the therapeutic effects.
abstract: OBJECTIVE
  The aim of this study was to compare the clinical effect of graciloplasty using two different gracilis encircled loops for the treatment of fecal incontinence after anoplasty for imperforate anus.
  
  
  METHODS
  From January 2009 to January 2012, 38 patients were treated by graciloplasty. The patients were randomly divided into two groups, one group consisting of 18 cases underwent the "γ-loop" and the other group consisting of 20 cases underwent the "υ-loop." All patients underwent postoperative defecation training and regular follow-up. All patients were evaluated via Wexner score and anal manometry (including anal resting pressure, anal maximal squeeze pressure, duration of anal squeeze, and rectal maximum tolerable volume) before and after graciloplasty. In addition, it was assessed whether the patients had difficulty defecating while squatting after surgery.
  
  
  RESULTS
  The surgeries on the 38 patients were accomplished successfully. There were no differences in postoperative complications between the two groups (P > 0.05). The Wexner score and anal manometry parameters of the two groups were gradually improved after operation. The generalized estimating equation results of the Wexner score indicated that the difference of measurement time was statistically significant (P < 0.05) but the difference of measurement group was not statistically significant (P > 0.05). The results of anal manometry parameters using repeated measures ANOVA indicated that differences between different time points were statistically significant (all P < 0.05) but differences between different surgery groups were not statistically significant (all P > 0.05). Regarding the postoperative defecating difficulties while squatting, the probability of occurrence in the "γ-loop" group was significantly higher than that in the "υ-loop" group. The difference between the two groups was statistically significant (P < 0.05).
  
  
  CONCLUSIONS
  Graciloplasty with different gracilis loops can improve anal function in patients. However, "υ-loop" can significantly improve difficulties in defecating while squatting.
authors.affiliation: Department of Colorectal Surgery, The Second Hospital of Tianjin Medical University, Tianjin, China.
authors.forename: Gang-Gang
authors.initials: GG
authors.lastname: Shi
authors.affiliation: Department of Colorectal Surgery, The Second Hospital of Tianjin Medical University, Tianjin, China.
authors.forename: Hui
authors.initials: H
authors.lastname: Wang
authors.affiliation: Department of Colorectal Surgery, The Second Hospital of Tianjin Medical University, Tianjin, China.
authors.forename: Li
authors.initials: L
authors.lastname: Wang
authors.affiliation: Department of Colorectal Surgery, The Second Hospital of Tianjin Medical University, Tianjin, China.
authors.forename: Zuo-Xing
authors.initials: ZX
authors.lastname: Zhang
authors.affiliation: Department of General Surgery, Tianjin Medical University General Hospital, Tianjin, China. tjwh2015@126.com.
authors.forename: Hao
authors.initials: H
authors.lastname: Wang
mesh_terms: D000293:Adolescent; D000328:Adult; D001003:Anal Canal / Q000502:physiology / Q000601:surgery*; D001006:Anus, Imperforate / Q000150:complications / Q000601:surgery*; D003672:Defecation; D005242:Fecal Incontinence / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D018482:Muscle, Skeletal / Q000601:surgery*; D011183:Postoperative Complications / Q000503:physiopathology / Q000601:surgery*; D011187:Posture; D055815:Young Adult
keywords: Anal sphincter; Difficulty defecating; Fecal incontinence; Graciloplasty; Squatting