Gracilis muscle transposition as a workhorse flap for anal incontinence: Quality of life and functional outcome in adults

ABSTRACT

Background/Purpose: Anal incontinence is one of the most psychologically and socially debilitating conditions in an otherwise healthy individual. It can lead to social isolation, loss of self-esteem, self-confidence and depression. This study is devoted to the problem of anal incontinence in the adult patients. The aim of our study is to analyse the results of gracilis muscle transposition for anal incontinence and improvement in quality of life (QOL) of patients. Materials and Methods: This was a retrospective study. A total of 18 patients with complaint of anal incontinence were enrolled in this study. All patients were treated with gracilis muscle transposition. Results: All patients are continent, and there is an improvement in their QOL. Conclusion: Gracilis muscle transposition is a good option for patients of anal incontinence who are not treated by non-surgical means.

KEY WORDS

Anal incontinence - gracilis sling - quality of life

 

Conflicts of interest

There are no conflicts of interest.

• REFERENCES

• 1 Kaiser AM. ASCRS core subjects: Fecal incontinence. Annual Meeting: ASCRS; 2012
• 2 Wolff BG. The ASCRS Textbook of Colon and Rectal Surgery. New York: Springer; 2007: p. 653-64
• 3 Yamada T, Alpers DH. Textbook of Gastroenterology. Vol. 5. Chichester, West Sussex: Blackwell Publishing; 2009: p. 1717-44
• 4 Norton C, Thomas L, Hill J. Guideline Development G. Management of faecal incontinence in adults: Summary of NICE guidance. BMJ 2007; 334: 1370-1
• 5 Abrams P. Pathophysiology of urinary incontinence, faecal incontinence and pelvic organ prolapse. Incontinence: 4th International Consultation on Incontinence. Vol. 4. Paris: Paris Health Publications; 2009: p. 255
• 6 Zbar AP, Wexner SD. editors Coloproctology. New York: Springer; 2010: p. 109-19
• 7 Abrams P. Epidemiology of urinary (UI) and faecal (FI) incontinence and pelvic organ prolapse (POP). Incontinence: 4th International Consultation on Incontinence. Vol. 4. Paris: Paris Health Publications; 2009: p. 35
• 8 Ommer A, Wenger FA, Rolfs T, Walz MK. Continence disorders after anal surgery – a relevant problem?. Int J Colorectal Dis 2008; 23: 1023-31
• 9 Rieger N, Wattchow D. The effect of vaginal delivery on anal function. Aust N Z J Surg 1999; 69: 172-7
• 10 Rockwood TH, Church JM, Fleshman JW, Kane RL, Mavrantonis C, Thorson AG. et al. Fecal incontinence quality of life scale: Quality of life instrument for patients with fecal incontinence. Dis Colon Rectum 2000; 43: 9-16
• 11 Sangwan YP, Coller JA. Fecal incontinence. Surg Clin North Am 1994; 74: 1377-98
• 12 Chetwood CH. Plastic operation of the sphincter ani with report of a case. Med Rec 1902; 61: 529
• 13 Pickrell KL, Broadbent TR, Masters FW, Metzger JT. Construction of a rectal sphincter and restoration of anal continence by transplanting the gracilis muscle; a report of four cases in children. Ann Surg 1952; 135: 853-62
• 14 Mander BJ, Wexner SD, Williams NS, Bartolo DC, Lubowski DZ, Oresland T. et al. Preliminary results of a multicentre trial of the electrically stimulated gracilis neoanal sphincter. Br J Surg 1999; 86: 1543-8
• 15 Wexner SD, Baeten C, Bailey R, Bakka A, Belin B, Belliveau P. et al. Long-term efficacy of dynamic graciloplasty for fecal incontinence. Dis Colon Rectum 2002; 45: 809-18
• 16 Wexner SD, Gonzalez-Padron A, Rius J, Teoh TA, Cheong DM, Nogueras JJ. et al. Stimulated gracilis neosphincter operation. Initial experience, pitfalls, and complications. Dis Colon Rectum 1996; 39: 957-64
• 17 Matzel KE, Madoff RD, LaFontaine LJ, Baeten CG, Buie WD, Christiansen J. et al. Complications of dynamic graciloplasty: Incidence, management, and impact on outcome. Dis Colon Rectum 2001; 44: 1427-35
• 18 Yoshioka K, Keighley MR. Clinical and manometric assessment of gracilis muscle transplant for fecal incontinence. Dis Colon Rectum 1988; 31: 767-9
• 19 Mowatt G, Glazener C, Jarrett M. Sacral nerve stimulation for fecal incontinence and constipation in adults: A short version Cochrane review. Neurourol Urodyn 2008; 27: 155-61
• 20 Schrag HJ, Ruthmann O, Doll A, Goldschmidtböing F, Woias P, Hopt UT. Development of a novel, remote-controlled artificial bowel sphincter through microsystems technology. Artif Organs 2006; 30: 855-62
• 21 Parisien CJ, Corman ML. The Secca procedure for the treatment of fecal incontinence: Definitive therapy or short-term solution. Clin Colon Rectal Surg 2005; 18: 42-5
• 22 Corman M. Gracilis muscle transposition for anal incontinence: Late results. Br J Surg 1985; 72 Suppl S21-S22
• 23 Sielezneff I, Bauer S, Bulgare JC, Sarles JC. Gracilis muscle transposition in the treatment of faecal incontinence. Int J Colorectal Dis 1996; 11: 15-8
• 24 Eccersley AJ, Lunniss PJ, Williams NS. Unstimulated graciloplasty in traumatic faecal incontinence. Br J Surg 1999; 86: 1071-2
• 25 Salmons S, Henriksson J. The adaptive response of skeletal muscle to increased use. Muscle Nerve 1981; 4: 94-105