Muscle Transposition: Does It Still Have a Role?

 

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ABSTRACT

Since the early 1900s, skeletal muscle transpositions have been employed for complicated cases of fecal incontinence to augment or replace the anal sphincter. Multiple techniques have evolved that vary with the type and configuration of muscle used in the reconstruction. Transposition of the gluteus maximus muscle was popular in the early stages of development but was replaced by techniques involving transposition of the gracilis muscle. Within the past 16 years, electrical stimulators have been applied to the transposed muscle flaps to create a dynamic reconstruction improving the efficacy of these neosphincters over their static counterparts. However, the stimulated versions are technically demanding with a high rate of morbidity secondary to complications of the multiple components and variations in technique. The stimulator used in this procedure has been removed from the US market, although it is still available in other countries. Currently in the United States, gracilis transposition is still employed in the absence of an electrical stimulator as an adjunct to the artificial bowel sphincter (Acticon Neosphincter^TM, American Medical Systems, Minnetonka, MN), such as in cases of severe muscle loss and congenital atresia. In European countries, the stimulated graciloplasty continues to evolve, leading to expansion of its use in total anorectal reconstruction for anal atresia and after abdominoperineal resection.

REFERENCES

• 1 Bravo Guierrez A, Madoff R D, Lowry A C, Parker S C, Buie W D, Baxter N N. Long-term results of anterior sphincteroplasty.  Dis Colon Rectum. 2004;  47 727-731 , discussion 731-732
  CrossrefPubMedGoogle Scholar
• 2 Wexner S D, Marchetti F, Jagelman D. The role of sphincteroplasty for fecal incontinence reevaluated: a prospective physiologic and functional review.  Dis Colon Rectum. 1991;  34 22-30
  PubMedGoogle Scholar
• 3 Chetwood C H. Plastic operation of the sphincter ani with report of a case.  Med Rec. 1902;  61 529
  PubMedGoogle Scholar
• 4 Wreden R R. A method of constructing a voluntary sphincter ani.  Arch Surg. 1929;  18 841
  PubMedGoogle Scholar
• 5 Pickrell K I, Broadbent T R, Masters F W et al.. Construction of rectal sphincter and restoration of anal continence by transplanting the gracilis muscle. Report of 4 cases in children.  Ann Surg. 1952;  135 853-862
  CrossrefPubMedGoogle Scholar
• 6 Salmons S, Henriksson J. The adaptive response of skeletal muscle to increased use.  Muscle Nerve. 1981;  4 94-105
  PubMedGoogle Scholar
• 7 Baeten C, Spaans F, Fluks A. An implanted neuromuscular stimulator for fecal continence.  Dis Colon Rectum. 1988;  31 134
  PubMedGoogle Scholar
• 8 Pearl R K, Prasad M L, Nelson R L, Orsay C P, Abcarian H. Bilateral gluteus maximus transposition for anal incontinence.  Dis Colon Rectum. 1991;  34 478-481
  PubMedGoogle Scholar
• 9 Christiansen J, Hansen C R, Rasmussen O. Bilateral gluteus maximus transposition for anal incontinence.  Br J Surg. 1995;  82 903-905
  PubMedGoogle Scholar
• 10 Devesa J M, Madrid J M, Gallego B R, Vicente E, Nuno J, Enriquez J M. Bilateral gluteoplasty for fecal incontinence.  Dis Colon Rectum. 1997;  40 883-888
  PubMedGoogle Scholar
• 11 Devesa J M, Vicente E, Enriquez J M et al.. Total fecal incontinence-a new method of gluteus maximus transposition. Preliminary results and report of previous experience with similar procedures.  Dis Colon Rectum. 1992;  35 339-349
  PubMedGoogle Scholar
• 12 Corman M L. Gracilis muscle transposition for anal incontinence: late results.  Br J Surg. 1985;  72 S21
  PubMedGoogle Scholar
• 13 Christiansen J, Sorensen M, Rasmussen O. Gracilis muscle transposition for fecal incontinence.  Br J Surg. 1990;  77 1039-1040
  CrossrefPubMedGoogle Scholar
• 14 Sielezneff I, Bauer S, Bulgare J C, Sarles J C. Gracilis muscle transposition in the treatment of faecal incontinence.  Int J Colorectal Dis. 1996;  11 15-18
  CrossrefPubMedGoogle Scholar
• 15 Yoshioka K, Keighley M R. Clinical and manometric assessment of gracilis muscle transplant for fecal incontinence.  Dis Colon Rectum. 1988;  31 767-769
  PubMedGoogle Scholar
• 16 Eccersley A J, Lunniss P J, Williams N S. Unstimulated graciloplasty in traumatic faecal incontinence.  Br J Surg. 1999;  86 1071-1072
  CrossrefPubMedGoogle Scholar
• 17 Kumar D, Hutchinson R, Grant E. Bilateral gracilis neosphincter construction for treatment of faecal incontinence.  Br J Surg. 1995;  82 1645-1647
  PubMedGoogle Scholar
• 18 Mander B J, Wexner S D, Williams N S et al.. Preliminary results of a multicenter trial of the electrically stimulated gracilis neoanal sphincter.  Br J Surg. 1999;  86 1543-1548
  CrossrefPubMedGoogle Scholar
• 19 Wexner S D, Baeten C, Bailey R et al.. Long-term efficacy of dynamic graciloplasty for fecal incontinence.  Dis Colon Rectum. 2002;  45 809-818
  CrossrefPubMedGoogle Scholar
• 20 Wexner S D, Gonzalez-Padron A, Rius J et al.. Stimulated gracilis neosphincter operation. Initial experience, pitfalls, and complications.  Dis Colon Rectum. 1996;  39 957-964
  PubMedGoogle Scholar
• 21 Matzel K E, Madoff R D, LaFontaine L J et al.. Dynamic Graciloplasty Therapy Study Group. Complications of dynamic graciloplasty: incidence, management, and impact on outcome.  Dis Colon Rectum. 2001;  44 1427-1435
  CrossrefPubMedGoogle Scholar
• 22 Mavrantonis C, Billotti V L, Wexner S D. Stimulated graciloplasty for treatment of intractable fecal incontinence: critical influence of the method of stimulation.  Dis Colon Rectum. 1999;  42 497-504
  PubMedGoogle Scholar
• 23 Konsten J, Rongen M J, Ogunbiyi O A, Darakhshan A, Baeten C G, Williams N S. Comparison of epineural or intramuscular nerve electrodes for stimulated graciloplasty.  Dis Colon Rectum. 2001;  44 581-586
  PubMedGoogle Scholar
• 24 Rongen M J, Uludag O, El Naggar K, Geerdes B P, Konsten J, Baeten C G. Long-term follow-up of dynamic graciloplasty for fecal incontinence.  Dis Colon Rectum. 2003;  46 716-721
  CrossrefPubMedGoogle Scholar
• 25 Madoff R D, Rosen H R, Baeten C G et al.. Safety and efficacy of dynamic muscle plasty for anal incontinence: lessons from a prospective, multicenter trial.  Gastroenterology. 1999;  116 549-556
  CrossrefPubMedGoogle Scholar
• 26 Williams N S, Ogunbiyi O A, Scott S M, Fajobi O, Lunniss P J. Rectal augmentation and stimulated gracilis anal neosphincter: a new approach in the management of fecal urgency and incontinence.  Dis Colon Rectum. 2001;  44 192-198
  PubMedGoogle Scholar
• 27 Baeten C G, Bailey H R, Bakka A et al.. Safety and efficacy of dynamic graciloplasty for fecal incontinence: report of a prospective, multicenter trial. Dynamic Graciloplasty Therapy Study group.  Dis Colon Rectum. 2000;  43 743-751
  CrossrefPubMedGoogle Scholar
• 28 Bresler L, Reibel N, Brunaud L et al.. Dynamic graciloplasty in the treatment of severe fecal incontinence. French multicentric retrospective study [in French].  Ann Chir. 2002;  127 520-526
  CrossrefPubMedGoogle Scholar
• 29 Simonsen O S, Stolf N A, Aun F, Raia A, Habr-Gama A. Rectal sphincter reconstruction in perineal colostomies after abdominoperineal resection for cancer.  Br J Surg. 1976;  63 389-391
  PubMedGoogle Scholar
• 30 Cavina E, Seccia M, Chiarugi M. Total anorectal reconstruction supported by electrostimulated gracilis neosphincter.  Recent Results Cancer Res. 1998;  146 104-113
  PubMedGoogle Scholar
• 31 Rouanet P, Senesse P, Bouamrirene D et al.. Anal sphincter reconstruction by dynamic graciloplasty after abdominoperineal resection for cancer.  Dis Colon Rectum. 1999;  42 451-456
  PubMedGoogle Scholar
• 32 Rullier E, Zerbib F, Laurent C, Caudry M, Saric J. Morbidity and functional outcome after double dynamic graciloplasty for anorectal reconstruction.  Br J Surg. 2000;  87 909-913
  CrossrefPubMedGoogle Scholar
• 33 Violi V, Roncoroni L, Boselli A S, De Cesare C, Livrini M, Peracchia A. Total anorectal reconstruction by double graciloplasty: experience with delayed, selective use of implantable pulse generators.  Int J Colorectal Dis. 1999;  14 164-171
  CrossrefPubMedGoogle Scholar
• 34 Saunders J R, Williams N S, Eccersley A J. The combination of electrically stimulated gracilis neoanal sphincter and continent colonic conduit: a step forward for total anorectal reconstruction?.  Dis Colon Rectum. 2004;  47 354-363
  CrossrefPubMedGoogle Scholar
• 35 Baeten C G, Konsten J, Heineman E, Soeters P B. Dynamic graciloplasty for anal atresia.  J Pediatr Surg. 1994;  29 922-924 , discussion 925
  CrossrefPubMedGoogle Scholar
• 36 da Silva G M, Jorge J M, Belin B et al.. New surgical options for fecal incontinence in patients with imperforate anus.  Dis Colon Rectum. 2004;  47 204-209
  CrossrefPubMedGoogle Scholar
• 37 Farid M, Moneim H A, Mahdy T, Omar W. Augmented unilateral gluteoplasty with fascia lata graft in fecal incontinence.  Tech Coloproctol. 2003;  7 23-28
  CrossrefPubMedGoogle Scholar
• 38 Chapman A E, Geerdes B, Hewett P et al.. Systematic review of dynamic graciloplasty in the treatment of faecal incontinence.  Br J Surg. 2002;  89 138-153
  PubMedGoogle Scholar
• 39 Adang E MM, Engel G L, Rutten F H, Geerdes B P, Baeten C G. Cost-effectiveness of dynamic graciloplasty in patients with fecal incontinence.  Dis Colon Rectum. 1998;  41 725-733 discusssion 733-734
  PubMedGoogle Scholar
• 40 Wong W D, Congliosi S M, Spencer M P et al.. Safety and efficacy of the artificial bowel sphincter for fecal incontinence: results from a multicenter cohort study.  Dis Colon Rectum. 2002;  45 1139-1153
  CrossrefPubMedGoogle Scholar
• 41 Ortiz H, Armendariz P, DeMiguel M, Solana A, Alos R, Roig J V. Prospective study of artificial anal sphincter and dynamic graciloplasty for severe anal incontinence.  Int J Colorectal Dis. 2003;  18 349-354
  PubMedGoogle Scholar

Steven D WexnerM.D. 

Department of Colorectal Surgery

Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd.

Weston, FL 33331

Email: mcderme@ccf.org