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Surgical Alternatives in Anal Sphincter Reconstruction

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Reconstructive Surgery of the Rectum, Anus and Perineum

Abstract

This chapter outlines the surgical alternatives in the management of the incontinent patient, detailing the results of stimulated and unstimulated graciloplasties and gluteus muscle transposition. Muscle transpositions have documented effectiveness as reconstructive procedures in the treatment of fecal incontinence. These procedures are technically challenging and carry a distinct probability of morbidity, although there is a significant body of literature that finds an equivalent quality of life for patients with a colostomy versus imperfect anorectal function after reconstructed sphincter preservation. The coloproctologist must incorporate the range of muscle transpositions in selected (often reoperated) cases as part of their surgical armamentarium.

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References

  1. Nelson R, Norton N, Cautley E, Furner S. Community-based prevalence of anal incontinence. JAMA. 1995;274:559–61.

    Article  PubMed  CAS  Google Scholar 

  2. Macmillan AK, Merrie AE, Marshall RJ, Parry BR. The prevalence of fecal incontinence in community-dwelling adults: a systematic review of the literature. Dis Colon Rectum. 2004;47:1341–9.

    Article  PubMed  Google Scholar 

  3. Madoff RD, Parker SC, Varma MG, Lowry AC. Fecal incontinence in adults. Lancet. 2004;364(9434):621–32.

    Article  PubMed  Google Scholar 

  4. Rockwood TH, Church JM, Fleshman JW, Kane RL, Mavrantonis C, Thorson AG, et al. Patient and surgeon ranking of the severity of symptoms associated with fecal incontinence: the fecal ­incontinence severity index. Dis Colon Rectum. 1999;42:1525–32.

    Article  PubMed  CAS  Google Scholar 

  5. 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;43:9–17.

    Article  PubMed  CAS  Google Scholar 

  6. Jorge JM, Wexner SD. Etiology and management of fecal ­incontinence. Dis Colon Rectum. 1993;36:77–97.

    Article  PubMed  CAS  Google Scholar 

  7. Macchi V, Vigato E, Porzionato A, Tiengo C, Stecco C, Parenti A, et al. The gracilis muscle and its use in clinical reconstruction: an anatomical, embryological, and radiological study. Clin Anat. 2008;21:696–704.

    Article  PubMed  CAS  Google Scholar 

  8. 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.

    Article  PubMed  CAS  Google Scholar 

  9. Spiegel JH, Lee C, Trabulsy PP, Coughlin RR. Endoscopic harvest of the gracilis muscle flap. Ann Plast Surg. 1998;41:384–9.

    Article  PubMed  CAS  Google Scholar 

  10. Hallock GG. Minimally invasive harvest of the gracilis muscle. Plast Reconstr Surg. 1999;104:801–5.

    PubMed  CAS  Google Scholar 

  11. Chapman AE, Geerdes B, Hewett P, Young J, Eyers T, Kiroff G, et al. Systematic review of dynamic graciloplasty in the treatment of fecal incontinence. Br J Surg. 2002;89:138–53.

    PubMed  CAS  Google Scholar 

  12. 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.

    Article  PubMed  Google Scholar 

  13. Thornton MJ, Kennedy ML, Lubowski DZ, King DW. Long-term follow-up of dynamic graciloplasty for fecal incontinence. Colorectal Dis. 2004;6:470–6.

    Article  PubMed  CAS  Google Scholar 

  14. Penninckx F. Belgian experience with dynamic graciloplasty for fecal incontinence. Br J Surg. 2004;91:872–8.

    Article  PubMed  CAS  Google Scholar 

  15. Koch SM, Uludağ O, El Naggar K, van Gemert WG, Baeten CG. Colonic irrigation for defecation disorders after dynamic ­graciloplasty. Int J Colorectal Dis. 2008;23:195–200.

    Article  PubMed  Google Scholar 

  16. Ho KS, Seow-Choen F. Dynamic graciloplasty for total anorectal reconstruction after abdominoperineal resection for rectal tumour. Int J Colorectal Dis. 2005;20:38–41.

    Article  PubMed  CAS  Google Scholar 

  17. Saunders JR, Williams NS, Eccersley AJ. The combination of electrically stimulated gracilis neoanal sphincter and continent colonic conduit: a step forward for total anorectal reconstruction? Dis Colon Rectum. 2004;47:354–66.

    Article  PubMed  Google Scholar 

  18. Konsten J, Baeten CG, Havenith MG, Soeters PB. Morphology of dynamic graciloplasty compared with the anal sphincter. Dis Colon Rectum. 1993;36:559–63.

    Article  PubMed  CAS  Google Scholar 

  19. Christiansen J, Sorensen M, Rasmussen OO. Gracilis muscle transposition for fecal incontinence. Br J Surg. 1990;77:1039–40.

    Article  PubMed  CAS  Google Scholar 

  20. Sielezneff I, Bauer S, Bulgare JC, Sarles JC. Gracilis muscle transposition in the treatment of fecal incontinence. Int J Colorectal Dis. 1996;11:15–8.

    Article  PubMed  CAS  Google Scholar 

  21. Niriella DA, Deen KI. Neosphincters in the management of fecal incontinence. Br J Surg. 2000;87:1617–28.

    Article  PubMed  CAS  Google Scholar 

  22. Shatari T, Fujita M, Kodaira S. Dynamic graciloplasty resulting fecal continence without electrical stimulation: report of a case. Surg Today. 2004;34:463–5.

    Article  PubMed  Google Scholar 

  23. Chetwood CH. Plastic operation of the sphincter ani with report of a case. Med Rec. 1902;61:529.

    Google Scholar 

  24. Wreden RR. A method of constructing a voluntary sphincter ani. Arch Surg. 1929;18:841.

    Article  Google Scholar 

  25. Guelinckx PJ, Sinsel NK, Gruwez JA. Anal sphincter ­reconstruction with the gluteus maximus muscle: anatomic and physiologic ­considerations concerning conventional and dynamic gluteoplasty. Plast Reconstr Surg. 1996;98:293–304.

    Article  PubMed  CAS  Google Scholar 

  26. Sato T, Konishi F, Endoh N, Uda H, Sugawara Y, Nagai H. ­Long-term outcomes of a neo-anus with a pudendal nerve ­anastomosis contemporaneously reconstructed with an abdominoperineal excision of the rectum. Surgery. 2005;137:8–15.

    Article  PubMed  Google Scholar 

  27. Devesa JM, Vicente E, Enriquez JM, Nuño J, Bucheli P, de Blas G, et al. Total fecal incontinence – a new method of gluteus maximus transposition: preliminary results and report of previous experience with similar procedures. Dis Colon Rectum. 1992;35:339–49.

    Article  PubMed  CAS  Google Scholar 

  28. Meehan JJ, Hardin Jr WD, Georgeson KE. Gluteus maximus augmentation for the treatment of fecal incontinence. J Pediatr Surg. 1997;32:1045–8.

    Article  PubMed  CAS  Google Scholar 

  29. Pak-Art R, Silapunt P, Bunaprasert T, Tansatit T, Vajrabukka T. Prospective, randomized, controlled trial of proximally based vs. distally based gluteus maximus flap for anal incontinence in cadavers. Dis Colon Rectum. 2002;45:1100–3.

    Article  PubMed  Google Scholar 

  30. Enriquez-Navascues JM, Devesa-Mugica JM. Traumatic anal incontinence. Role of unilateral gluteus maximus transposition supplementing and supporting direct anal sphincteroplasty. Dis Colon Rectum. 1994;37:766–9.

    Article  PubMed  CAS  Google Scholar 

  31. Tillin T, Chambers M, Feldman R. Outcomes of electrically stimulated gracilis neosphincter surgery. Health Technol Assess. 2005;9(28):iii, ix–xi, 1–102.

    PubMed  CAS  Google Scholar 

  32. Cornish JA, Tilney HS, Heriot AG, Lavery IC, Fazio VW, Tekkis PP. A meta-analysis of quality of life for abdominoperineal excision of rectum versus anterior resection for rectal cancer. Ann Surg Oncol. 2007;14:2056–68.

    Article  PubMed  Google Scholar 

  33. Tan EK, Vaizey C, Cornish J, Darzi A, Tekkis PP. Surgical strategies for fecal incontinence – a decision analysis between dynamic graciloplasty, artificial bowel sphincter and end stoma. Colorectal Dis. 2008;10:577–86.

    Article  PubMed  CAS  Google Scholar 

  34. Cera SM, Wexner SD. Muscle transposition: does it still have a role? Clin Colon Rectal Surg. 2005;18:46–54.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Surgery, Mayo Clinic, Phoenix, AZ, USA

    David A. Etzioni M.D., MSHS

  2. Department of Surgery, University of California, Irvine, CA, USA

    Michael J. Stamos M.D.

Authors
  1. David A. Etzioni M.D., MSHS
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  2. Michael J. Stamos M.D.
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Correspondence to Michael J. Stamos M.D. .

Editor information

Editors and Affiliations

  1. Tamworth Rural Referral Hospital, Dean Street, Tamworth, 2340, New South Wales, Australia

    Andrew P. Zbar

  2. Delware Street 420, Minneapolis, 55455, Minnesota, USA

    Robert D. Madoff

  3. , Dept. Colorectal Surgery, Cleveland Clinic, Florida, Cleveland Clinic Blvd. 2950, Weston, 33331, Florida, USA

    Steven Wexner

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© 2013 Springer-Verlag London

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Etzioni, D.A., Stamos, M.J. (2013). Surgical Alternatives in Anal Sphincter Reconstruction. In: Zbar, A., Madoff, R., Wexner, S. (eds) Reconstructive Surgery of the Rectum, Anus and Perineum. Springer, London. https://doi.org/10.1007/978-1-84882-413-3_32

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  • DOI: https://doi.org/10.1007/978-1-84882-413-3_32

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  • Publisher Name: Springer, London

  • Print ISBN: 978-1-84882-412-6

  • Online ISBN: 978-1-84882-413-3

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