What is dynamic graciloplasty for fecal incontinence?

Anthony L. Komaroff, MD
Internal Medicine
Dynamic graciloplasty is a technique for treating fecal incontinence (unintended passage of stool) that has not yet been approved by the Food and Drug Administration (FDA), although it is frequently performed in Europe. It may be effective if a patient's sphincter is damaged, and if there is also nerve damage to the anus. In this case, the surgeon wraps a piece of the gracilis muscle (from the inner thigh) around the anus to substitute for the damaged sphincter. The surgeon then implants a kind of pacemaker, similar to a sacral nerve stimulator. This keeps the newly created muscle closed, and prevents stool from leaking out.

In one U.S. report, researchers found that patients who had dynamic graciloplasty -- while remaining incontinent after the surgery -- showed a significant improvement in the extent of fecal incontinence and in their quality of life. Two years after this surgery, patients needed half as many pads to control their incontinence. The number of incontinent episodes involving solid stool dropped from 9.3 to 1.3 per week. And those involving liquid were reduced from 9.1 to 3.5.

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