Physiological and histochemical adaptation of the electrically stimulated gracilis muscle to neoanal sphincter function

Author:

George B D1,Williams N S1,Patel J1,Swash M2,Watkins E S3

Affiliation:

1. Department of Surgery, The Royal London Hospital, London E1 1BB, UK

2. Department of Pathology, The Royal London Hospital, London E1 1BB, UK

3. Department of Neurosurgery, The Royal London Hospital, London E1 1BB, UK

Abstract

Abstract The physiological and histochemical characteristics of the gracilis muscle were studied in 19 patients undergoing electrically stimulated gracilis neosphincter construction. Indications for surgery were faecal incontinence (n = 11) and reconstruction following sphincter excision or congenital absence (n = 8). Transposition of the gracilis muscle around the anal canal followed by chronic low-frequency electrical stimulation was associated with a shift in the frequency-response curve and a prolongation of the time-course of individual muscle twitches suggestive of transformation to a slow-twitch fatigue-resistant type. Temporary cessation of electrical stimulation resulted in a reversal of the frequency-response changes. Muscle biopsies taken before and a median of 80 (range 49–137) days after transposition and low-frequency electrical stimulation indicated a significant increase in the proportion of type 1 fibres and a significant decrease in their diameter. These results show that the human gracilis muscle is capable of physiological and histochemical adaptation to long-term neosphincter function.

Publisher

Oxford University Press (OUP)

Subject

Surgery

Reference22 articles.

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2. The use of superficial transverse perineal muscles in the treatment of post-surgical anal incontinence;State;Ann Surg,1955

3. Construction of a rectal sphincter and restoration of anal continence by transplanting the gracilis muscle;Pickrell;Ann Surg,1952

4. The internal obturator muscles functioning as the neosphincter of the anus. Neosphincter in short-term and long-term evaluation;Skacel;Acta Unit Palacki Olomuc Fac Med,1986

5. Treatment of patients with rectal cancer;Fedorov;Dis Colon Rectum,1989

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