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Neurostimulated levator augmentation—a new approach in restoring continence

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Purpose

Restoration of continence remains a major challenge in patients after abdominoperineal rectal excision (APE) or with end-stage fecal incontinence. A new surgical technique, the neurostimulated levator augmentation, was introduced for pelvic floor augmentation using dynamic graciloplasty in order to restore anorectal angulation. The aim of this study was to assess feasibility and efficiency.

Methods

From November 2009 to March 2014, n = 17 patients underwent neurostimulated levator augmentation (n = 10 after APE, n = 5 intractable idiopathic fecal incontinence, n = 2 traumatic anal amputation). Gracilis muscle was transposed through the obturator foramen into the pelvic cavity, positioned in a U-shaped sling behind the rectum, fixed to the contralateral os pubis to restore anorectal angulation, and then conditioned by neurostimulation. Questionnaires analyzing function and quality of life were administered.

Results

For neurostimulated levator augmentation, four patients suffered from complications that needed operative intervention (n = 3 wound infection, n = 1 colon perforation); three pharmacological treatment and two complications needed no further invasive intervention. One patient died due to causes unrelated to the operation, and no complication required intensive care management. Fecal incontinence in patients with idiopathic incontinence improved significantly after surgery as well as incontinence episodes, urgency, and disease-specific quality of life through all dimensions. Generic quality of life was significantly better after surgery in all patients. After median follow-up of 17 months (2–45), all but one patient would undergo the procedure again.

Conclusions

Neurostimulated levator augmentation was feasible in all patients with acceptable morbidity. It may represent a new therapeutic option in selected patients with intractable fecal incontinence.

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Authors and Affiliations

  1. Department of General, Gastrointestinal and Colorectal Surgery, Amalie-Sieveking Hospital, Haselkamp 33, 22359, Hamburg, Germany

    Christoph Isbert

  2. Department of General, Gastrointestinal, Vascular and Paediatric Surgery, University Hospital of Würzburg, Oberduerrbacher Str. 6, 97080, Würzburg, Germany

    Nicolas Schlegel, Joachim Reibetanz, Katica Krajinovic, Christoph-Thomas Germer & Mia Kim

  3. Department of Trauma, Hand, Plastic and Reconstructive Surgery, University Hospital of Würzburg, Oberduerrbacher Str. 6, 97080, Würzburg, Germany

    Karsten Schmidt

Authors
  1. Christoph Isbert
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  2. Nicolas Schlegel
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  3. Joachim Reibetanz
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  4. Katica Krajinovic
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  6. Christoph-Thomas Germer
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  7. Mia Kim
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Correspondence to Mia Kim.

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Isbert, C., Schlegel, N., Reibetanz, J. et al. Neurostimulated levator augmentation—a new approach in restoring continence. Int J Colorectal Dis 30, 505–512 (2015). https://doi.org/10.1007/s00384-015-2134-9

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  • DOI: https://doi.org/10.1007/s00384-015-2134-9

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