Use of a continent colonic conduit for treatment of refractory evacuatory disorder following construction of an electrically stimulated gracilis neoanal sphincter.

Abstract

This study reports the outcome from the addition of a continent colonic conduit (CCC) to an electrically stimulated gracilis neoanal sphincter in patients with severe evacuatory disorder following formation of a neosphincter for end-stage faecal incontinence. One hundred and twenty patients had an electrically stimulated gracilis neoanal sphincter constructed for end-stage faecal incontinence. Seven patients developed severe evacuatory disorders; construction of a CCC was required in six patients and an antegrade continence enema procedure in one. Median follow-up of the seven patients was 77 (range 6-96) months. Six patients with evacuatory disorders had a successful outcome, defined as continence to solid and liquid stool as well as correction of the evacuatory disorder. A stoma was formed in one patient. Patients who had previously undergone anorectal reconstructive surgery were more likely to develop an evacuatory disorder following construction of an electrically stimulated gracilis neoanal sphincter than patients operated on for other reasons (chi2 = 28.13, 1 d.f., P < 0.001). Construction of a CCC is a useful technique for the majority of patients with severe evacuatory disorders following the formation of an electrically stimulated gracilis neoanal sphincter, for whom the only alternative would be an end stoma. A CCC may be incorporated with construction of an electrically stimulated gracilis neoanal sphincter in patients at significant risk of postoperative severe evacuatory disorders.