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 20 February 2018

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Long-term follow-up of dynamic graciloplasty for fecal incontinence

A study in November's Colorectal Disease states that dynamic graciloplasty significantly improves patient quality of life and anal continence for some patients, however, obstructed defecation is a significant problem after graciloplasty and antegrade colonic enemas may be needed.

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Dr Thornton and colleagues undertook a follow-up study of patients who have undergone dynamic graciloplasty (DGP) for fecal incontinence.

The researchers looked at patients' long-term morbidity, function and quality of life.

The research group included a total of 38 patients who had undergone DGP at one institution between 1993 and 2003 in the study.

The researchers included 33 participants that were available for long-term follow-up (median 60 months).

These patients completed a telephone questionnaire assessing quality of life (QOL), bowel and sexual function and patient satisfaction.

All patients had interval anorectal physiology studies.

The researchers found that at a median follow-up of 5 years, 72% had pain, swelling or paraesthesia in the donor leg and 27% had sexual dysfunction.

In addition, the researchers noted that 16% of patients had been converted to an end-colostomy for persisting incontinence and 11% for obstructed defaecation.

Obstructed defecation is a significant problem after graciloplasty and antegrade colonic enemas may be needed
Colorectal Disease

All other patients have a normally functioning graciloplasty.

16% of patients reported a fecal continence score < 12.

The research group found that of those patients with a functioning graciloplasty, 50% had obstructed defecation and 64% reported that their bowel dysfunction had a negative impacted on their QOL.

Age, medical comorbidity and anal manometry did not correlate with functional outcome.

Quality of life scores and patient satisfaction scores correlated significantly with continence scores.

The research team noted that there was a trend toward higher QOL and satisfaction scores with conversion to colostomy compared with a continence score > 12.

Dr Thornton commented, "60% of patients rated their satisfaction with DGP as 50% or better on a visual analogue scale, and this correlated strongly with the continence score at the time of the assessment".

Dr Thornton concluded, "Dynamic graciloplasty significantly improves patient quality of life and anal continence for some patients."

"Despite increased experience, morbidity remains high and long-term continence scores are poor in a majority of cases."

"Obstructed defecation is a significant problem after graciloplasty and antegrade colonic enemas may be needed".

"Significant prognostic factors for obstructed defecation remain to be identified".

"The mechanism of both continence failure and surgical morbidity remains poorly defined in many patients and requires further investigation".

Colorectal Disease; 2004: 6 (6): 470
12 November 2004

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