Development of an electrically stimulated neoanal sphincter

Autor:	R. I. Hallan, B.D. George, N. S. Williams, J. Patel, E. S. Watkins
Rok vydání:	1991
Předmět:	Adult Male medicine.medical_specialty Contraction (grammar) Adolescent Anal Canal Electric Stimulation Therapy Stimulation Humans Medicine Gracilis muscle In patient Aged business.industry Muscles Skeletal muscle Equipment Design General Medicine Middle Aged Anal canal Combined Modality Therapy Electrodes Implanted Surgery medicine.anatomical_structure Evaluation Studies as Topic Sphincter Female business Anal sphincter Algorithms Fecal Incontinence Follow-Up Studies Muscle Contraction
Zdroj:	The Lancet. 338:1166-1169
ISSN:	0140-6736
DOI:	10.1016/0140-6736(91)92031-v
Popis:	In early surgical attempts to create a neoanal sphincter for patients who are faecally incontinent, skeletal muscle (usually the gracilis) has been transposed around the anal canal. Despite modifications, such as intermittent electrical stimulation, this procedure is likely to fail because the fast-twitch gracilis muscle is incapable of prolonged contraction without fatigue. Long-term electrical stimulation to convert such a muscle to a slow-twitch, fatigue-resistant muscle, though practicable, has yielded inconsistent results. We describe further modifications of this technique. A neoanal sphincter was constructed with an electrically stimulated transposed gracilis muscle in 20 incontinent patients with a deficient anal sphincter, and as part of a reconstruction in 12 patients in whom the anorectum had been excised or was congenitally absent. A totally implanted stimulator was used to convert the muscle from a fast-twitch to a slow-twitch muscle. Other modifications included vascular delay 4-6 weeks before transposition of the muscle, stimulation of the main nerve to the gracilis rather than its peripheral branches, and intermittent higher frequency stimulation. 2-4 of these modifications gave significantly fewer failures than did 0-1. With the new technique, continence has been restored in patients whose only other treatment option was a permanent stoma.
Databáze:	OpenAIRE
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