DYNAMIC GRACILOPLASTY IN TREATMENT OF SEVER FECAL INCONTINENCE: A PRELIMINARY REPORT ON THE SAFETY AND EFFICACY OF THE EGYPTIAN EXPERIENCE

Background: In the last decade, stimulated “dynamic” graciloplasty has shown promising results in the treatment of 
patients with fecal incontinence. Good results with dynamic graciloplasty have been reported by individual investigators, 
but the applicability of these results to a broader range of surgeons yet to be shown. 
Objectives: The aim of this report was to analyze the results of a single-stage using a single wrap dynamic graciloplasty 
in patients with fecal incontinence and to show problems and pitfalls that had arisen during the learning curve of the early phase procedures. 
Patients and Methods: This study included 6 patients (4 females and 2 males) with end stage fecal incontinence. They 
were treated by dynamic graciloplasty. The indications were congenital anal atresia in 3 patients, sacral meningocele in one patient, and spina bifida in one patient, and total anorectal reconstruction (TAR) following APR in the past in one patient. 
Muscle transposition, implantation of stimulation electrodes and pulse generator were done as a single-stage procedure, the "neosphincter" was wrapped in a split-sling technique. Muscle transformation was performed by controlled neuromuscular stimulation during 8 weeks. Quality of life Assessment were performed using Fecal Incontinence Quality of Life Scale. 
Results: No postoperative mortality (90 days) was observed in our series. In our early experience, the device problems 
occurred in 3 patients as the most prominent difficulty. Evaluation of the functional outcome showed perfect results in 2 
patients who achieved continence for solids and liquids or solids alone (1 or 2 according to Williams' score) and a satisfying outcome (continence for solids alone with occasional episodes for liquids) in 4 patients. The pre-operative quality of life of our patients was extensively impaired. Dynamic graciloplasty resulted in improvement in seven out of eight examined domains of quality of life. 
Conclusion: In this preliminary study, we have been able to perform dynamic graciloplasty as a one-stage procedure 
using a split-sling-technique. The procedure is associated with significant morbidity that is easily treated with successful 
outcome. Dynamic graciloplasty results in significant better quality of life. Finally, the results of our learning period 
encourage further application.