International Surgery Journal | October-December 2016 | Vol 3 | Issue 4 Page 2146 International Surgery Journal Chandrakasan C et al. Int Surg J. 2016 Nov;3(4):2146-2149 http://www.ijsurgery.com pISSN 2349-3305 | eISSN 2349-2902 Original Research Article Role of adynamic graciloplasty in intractable fecal incontinence: initial results from a tertiary centre in South India Chandramaliteeswaran Chandrakasan*, Venkatarami Reddy V., Dinakar Reddy A., Brahmeshwara Rao Musunuru, Varun Dasari, Nitesh Naga Balaji Pagadala INTRODUCTION Anal incontinence is a socially crippling disorder affecting up to 2% of general population. 1 Common causes include sphincter injury resulting from birth trauma, congenital anal atresia, anorectal surgeries, perineal injuries and spinal cord injuries. 2 Those patients who fail conservative measures like biofeedback therapy and dietary measures are candidates for sphincteroplasty surgeries based on degree of sphincter defect. For patients with extensive sphincter damage who are not willing for permanent colostomy, either artificial bowel sphincter implantation or surgical repair with autologous muscle remains the last resort. 3 Of the various skeletal muscle transposition surgeries used as neo-sphincter described in literature, gracilis muscle transposition also termed as graciloplasty is widely practiced. Pickrell et al originally described this technique reporting 100% success rate, followed by reports of significant improvement in continence rates by Corman et al and Faucheron et al. 4-6 This unstimulated (adynamic) graciloplasty gave way to electrically stimulated (dynamic) graciloplasty based on experimental studies which showed that electrical stimulation of the muscle could transform type II, fatigue-prone muscles into type I, fatigue-resistant muscles. 7-10 Though the dynamic graciloplasty gained popularity, the outcomes were variable with success rates ranging from 45-80% with higher cost of surgery and higher complications rates. 11-13 ABSTRACT Background: Anal incontinence is a socially crippling disorder affecting up to 2% of general population. For patients with extensive sphincter damage who are not willing for permanent colostomy, either artificial bowel sphincter or muscle transposition like graciloplasty remains the last resort. This study was aimed at reporting the outcomes of adynamic graciloplasty in four of our patients with end stage fecal incontinence. Methods: This was a prospective observational study of all four patients with end stage fecal incontinence who underwent adynamic graciloplasty from January 2014 to January 2016. Results: Study group included four patients; etiology was perinatal injury in both female patients and penetrating trauma in both male patients. Surgery was uneventful in all cases. FISI scores improved in all cases. Conclusions: Adynamic graciloplasty is safe and feasible option in surgical management of select cases of intractable fecal incontinence with satisfactory results. It may be offered as a salvage surgery before condemning these patients to permanent colostomy. Keywords: Adynamic graciloplasty, Anal incontinence, Surgery Department of Surgical Gastroenterology, Sri Venkateshwara institute of Medical Sciences, Tirupati, Andhra Pradesh, India Received: 30 July 2016 Accepted: 03 September 2016 *Correspondence: Dr. Chandramaliteeswaran Chandrakasan, E-mail: yogimouli1981@gmail.com Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. DOI: http://dx.doi.org/10.18203/2349-2902.isj20163589