The Colorectal Development Unit: impact on functional outcome for the electrically stimulated gracilis neoanal sphincter.

OBJECTIVE: A Colorectal Development Unit (CDU) was established to treat patients with end stage faecal incontinence with the electrically stimulated gracilis neoanal sphincter (ESGN). The aim of this study was to investigate the impact of the CDU on functional outcome and complications. METHODS: From March 1997 to March 2003, 53 patients underwent ESGN formation. Results were compared with 65 patients undergoing ESGN surgery prior to the establishment of the unit (pre-CDU) between 1988 and 1997, which were similar with regard to age, sex, aetiology and follow-up. RESULTS: Thirty-three (70%) CDU patients had a good functional outcome defined as continence to solid and liquid stool, a significant improvement when compared to the pre-CDU group, successful in 29 (45%) (P = 0.01). Episodes of technical complications leading to stimulator replacement were significantly reduced, from 25 to 3 over time (P < 0.001). Severe septic episodes were significantly reduced from 21 to four (P = 0.003) but there was no significant change in the incidence of postoperative evacuatory dysfunction. CONCLUSION: Since setting up a CDU, a successful outcome has been achieved in 33 (70%) of 47 patients undergoing ESGN surgery, which represents a significant improvement over time. This is probably related to improved patient assessment and selection, more reliable equipment and increased operative and peri-operative experience that come with a multidisciplinary team approach.

Use of a continent colonic conduit for treatment of refractory evacuatory disorder following construction of an electrically stimulated gracilis neoanal sphincter.

BACKGROUND: This study reports the outcome from the addition of a continent colonic conduit (CCC) to an electrically stimulated gracilis neoanal sphincter in patients with severe evacuatory disorder following formation of a neosphincter for end-stage faecal incontinence. METHODS: One hundred and twenty patients had an electrically stimulated gracilis neoanal sphincter constructed for end-stage faecal incontinence. Seven patients developed severe evacuatory disorders; construction of a CCC was required in six patients and an antegrade continence enema procedure in one. RESULTS: Median follow-up of the seven patients was 77 (range 6-96) months. Six patients with evacuatory disorders had a successful outcome, defined as continence to solid and liquid stool as well as correction of the evacuatory disorder. A stoma was formed in one patient. Patients who had previously undergone anorectal reconstructive surgery were more likely to develop an evacuatory disorder following construction of an electrically stimulated gracilis neoanal sphincter than patients operated on for other reasons (chi2 = 28.13, 1 d.f., P < 0.001). CONCLUSION: Construction of a CCC is a useful technique for the majority of patients with severe evacuatory disorders following the formation of an electrically stimulated gracilis neoanal sphincter, for whom the only alternative would be an end stoma. A CCC may be incorporated with construction of an electrically stimulated gracilis neoanal sphincter in patients at significant risk of postoperative severe evacuatory disorders.