Belgian experience with dynamic graciloplasty for faecal incontinence

Background: Dynamic graciloplasty (DGP) is an option in patients with end-stage faecal incontinence. The aim of this retrospective multicentre study was to assess early and late outcome after DGP. Methods: Sixty consecutive patients with congenital (14) or acquired (40) faecal incontinence or who had undergone total anorectal reconstruction (six) underwent DGP. Patients were followed up for a median of 48 (range 13 - 117) months. Results: There were no deaths; 75 complications that required 61 reoperations were observed in 44 patients. Loss of muscle stimulation occurred in 22 patients, more frequently after direct nerve stimulation. Evacuation difficulties occurred in 12 patients. Overall, DGP failed in 27 patients, of whom seven had stoma construction. At follow-up, continence to solid stool without stoma was obtained in 47 of 60 patients, although 26 required use of antegrade continence enemas or other measures. Functional outcome was related to the presence of a functioning DGP and a short delay (less than 50 days) of muscle training after transposition. Conclusion: DGP is a major operation with a high morbidity rate; it requires experience and early muscle training. The outcome after DGP should be compared prospectively with that after implantation of an artificial sphincter or other less expensive alternatives.