Die elektrodynamische Relaxationsplastik: Konzeption eines neuen elektrodynamischen glattmuskulären Sphinkterersatzes

Abstract

A novel artificial electrodynamic smooth muscle sphincter (ESMS) has been developed and was examined in a new in vitro ileostomy model. The ESMS is based on electrorelaxation of an intestinal smooth muscle frill which occludes a partially isolated bowel. In a first step, the isometric tension from isolated circular porcine fundas and colon muscle strips was recorded during pharmacological and electrical field stimulation (EFS). The relaxation response on prestimulated preparations by acetylcholine (ACh 10^-5 M) using EFS (40 Hz, 60 mA, 5 ms, train duration 1 s) was significantly higher in fundas muscle than in colon preparations. After free transplantation of a fundas muscle flap (6 cm long, 3 cm wide) around the isolated small intestine and simulation of the functional cholinergic activity in response to ACh ( 10^-4 M) a continent artificial sphincter was achieved. Electrical stimulation of the free nerve fibers of the fundas muscle frill caused muscle relaxation with the concomitant reduction of the occlusion pressure. ESMS is a promising innovative experimental model and will be further developed in the surgical treatment of fecal incontinence.