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Non-dynamic graciloplasty is an effective treatment for patients with passive fecal incontinence

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Abstract

Background

Fecal incontinence is a multifactorial problem and its etiology is complex. Various therapies are available and different success rates have been described. The aim of this study was to assess the effectiveness and safety of non-dynamic graciloplasty in patients with passive fecal incontinence.

Methods

We retrospectively studied charts of patients with fecal incontinence treated with graciloplasty at our institution from November 2015 until June 2018. Patients were included according to the following criteria: (1) presence of predominantly passive fecal incontinence and (2) presence of a lax perineal body. Primary outcome was the effectiveness, defined as a significant reduction or absence of the complaints of passive fecal incontinence at 3, 6 and 12 months after surgery. Second, we studied the safety of the procedure evaluating the complications within 30 days after surgery.

Results

Thirty-one patients met the inclusion criteria. Twenty-six of them, in addition to passive incontinence as the main symptom, had some degree of fecal urgency. The median age at the first visit to the outpatient clinic was 64.0 years (IQR 52–68). Most patients were female (n = 29, 94%). At 3 months after graciloplasty, 71% (22 of 31) of patients were successfully treated for their passive fecal incontinence. At 6 months, the success rate of the graciloplasty increased to 77%. At 12 months among the patients who were still seen in the clinic, the success rate was 58% (18/31). Two patients cancelled follow-up visits after 3 months, because of failure to control symptoms in 1 case. After 6 months, 9 patients were given the choice to do telephone follow-up only. Of these 11 patients without in-person follow-up, 10 were contacted 1 year after surgery and in 7 of them, the graciloplasty was effective in controlling their passive fecal incontinence for an overall success rate of 80% (25/31). Of the 26 patients with mixed passive and urge incontinence, 6 (23%) still complained of urge incontinence at 1 year. Of these patients with persistent urge incontinence, 6 underwent sacral nerve stimulation which was successful in 4. Two serious complications occurred within 30 days. A rectal perforation requiring temporary colostomy and a recto-vaginal fistula which was successfully repaired.

Conclusion

Non-dynamic graciloplasty is an effective treatment for passive fecal incontinence. Differentiation based on subtypes of fecal incontinence might be important for a pattern-specific approach to treatment. More research is necessary to determine the right indications for more invasive treatments of fecal incontinence.

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Acknowledgements

We would like to thank Herand Abcarian for his critical view and constructive comments on this manuscript.

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Authors and Affiliations

  1. Department of Surgery, Groene Hart Ziekenhuis, Bleulandweg 10, 2803 HH, Gouda, The Netherlands

    M. E. Knol, H. S. Snijders, J. T. M. van der Heyden & C. I. M. Baeten

  2. Department of Anatomy and Embryology, Leiden University Medical Center, Leiden, The Netherlands

    M. E. Knol & M. C. DeRuiter

  3. Department of Surgery, Alrijne Hospital, Leiderdorp, The Netherlands

    S. M. P. Koch

Authors
  1. M. E. Knol
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  2. H. S. Snijders
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  3. M. C. DeRuiter
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  4. S. M. P. Koch
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  5. J. T. M. van der Heyden
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  6. C. I. M. Baeten
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Contributions

MEK: contribution to the study conception and design, collecting data, conduct statistical analysis, interpreting data, drafting the manuscript. HSS: contribution to the study conception and design, interpreting data, commenting on the manuscript. MCD: interpreting data, commenting on the manuscript. SMPK: interpreting data, commenting on the manuscript. JTMH: contribution to the study conception and design, interpreting data, commenting on the manuscript. CIMB: contribution to the study conception and design, interpreting data, commenting on the manuscript. All authors approved the final version of the manuscript.

Corresponding author

Correspondence to C. I. M. Baeten.

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All authors declare that they have no conflict of interest.

Conflict of interest

The study has been approved by the local research comittee (Ll/2018-36).

Conflict of interest

Written informed consent was obtained from patients.

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Knol, M.E., Snijders, H.S., DeRuiter, M.C. et al. Non-dynamic graciloplasty is an effective treatment for patients with passive fecal incontinence. Tech Coloproctol 25, 849–855 (2021). https://doi.org/10.1007/s10151-021-02455-2

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  • DOI: https://doi.org/10.1007/s10151-021-02455-2

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