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Graciloplasty is the surgical treatment for fecal incontinence. Incontinence is the inability to control the passing of the stools or gas. This can vary from a small leak to a total loss of control.
How is Fecal incontinence Fixed
Fecal incontinence result when the muscles that control the passage of stools are destroyed or loose their function. The condition can be permanently fixed only by surgical intervention. One way is by creating an artificial sphincter and fixing it to the anus. This can also be corrected by just tightening the sphincter muscles using sutures. When the damage is too extensive, the surgeon chooses to create an alternative route for emptying the bowel, by attaching the end of the large intestine to an opening created on the surface of the skin over the belly. The bowel contents will be then collected in a bag (colostomy bag), that hangs outside the belly.
Graciloplasty is a new technique gaining acceptance for the correction of fecal incontinence. In this procedure, the gracilis muscle from the thigh is transposed onto the anus to replace the damaged sphincter muscles.
The thigh muscles contain fast twitching fibers that contract very quickly. But in order for it to appropriately replace the anal sphincter muscle and carry out its function, these fast twitching fibers must be converted into slow twitching fibers. This can be achieved by continuous long term electrical stimulations.
The Gracilis muscle of the thigh is the most superficial and easily accessible muscle of the thigh. It also has very good blood and nerve supply. All these features make the muscle an excellent candidate for grafting. Moreover, the muscle is long and can be easily overlapped around the anus. However, the muscle itself has very little impact on the motion of legs. So removing this muscle has no impact in performing everyday activities, including sports.
How is Graciloplasty carried out
Isolating the Gracilis muscle
A single incision is made over the inner aspect of the thigh. The Gracicilis muscle is then identified and small blood vessels supplying the muscle are tied up to prevent bleeding.
Dissection of the muscle
The muscle is carefully separated from its surrounding structures, until the main bundle of blood vessels and nerves are reached.
Creation of anal tunnel
Two incisions are made near the anus, through which tunnels are created within the anus, using fingers. Care should be taken not to injure the rectum, and vagina in females.
Connecting anus and thigh
Next, a tunnel connecting the thigh and the anal incisions is made. This tunnel should be wide enough to accomodate the Gracilis muscle, so as to prevent muscle entrapment.
Creating the anal wrap
The gracilis muscle is now pulled up from the thigh to the anus through the created tunnel. The muscle is then wrapped around in a circular fashion around the anus. The aim is to encircle the anus with muscular tissue as much as possible. The end of the gracilis tendon is then sutured to the hip bone.
The incision over the thigh is sutured and closed. Bleeding is controlled.
Whatever may be the cause of fecal incontinence, treating the condition improves the quality of ones life and saves one from the embarrassment faced due to a leaking bowel.
Dr. J. S. Rajkumar
M.S., F.I.C.S., Dip. N.B. (SURG.), F.R.C.S. (ENG.), F.R.C.S. (EDIN.), F.R.C.S. (GLASGOW), F.R.C.S. (IRELAND), F.I.M.S., F.A.I.S., F.R.M.S. (LONDON), F.A.E. (GASTRO), F.A.C.G. (USA), F.I.C.A. (USA), F.I.A.G.E.S., Dip M.I.S. (FR.)