Endoscopic Stimulated Graciloplasty – For The Treatment Of Faecal Incontinence

  • Reference Number: HEY-021/2016
  • Departments: Colorectal Surgery

This leaflet has been produced to give you general information. Most of your questions should be answered by this leaflet. It is not intended to replace the discussion between you and the healthcare team, but may act as a starting point for discussion. If after reading it you have any concerns or require further explanation, please discuss this with a member of the healthcare team.

Introduction

This leaflet has been produced to give you general information about your procedure.  Most of your questions should be answered by reading this leaflet.  It is not intended to replace the discussion between you and your doctor, but may act as a starting point for discussion.   If after reading it you have any concerns or require further explanation, please discuss this with a member of the healthcare team caring for you.

Endoscopic Stimulated Graciloplasty is offered to people with faecal incontinence. Normally when someone needs to empty their bowels, they can “hold on” until they need to go. One of the ways the body does this is to close the muscle around the exit of the rectum; this is called the anal sphincter. If the anal sphincter is weak or damaged, this can cause faecal incontinence.

What is an endoscopic stimulated graciloplasty?

You will have been troubled by faecal incontinence. Following discussion with your doctor they have advised an endoscopic stimulated graciloplasty. The procedure takes the gracilis muscle (this runs along the inside of the leg from the groin to above the knee) and wraps this around the anal canal through two incisions made near the anal canal (the opening to the rectum) to form a new ring of muscle. The muscle is usually moved endoscopically (keyhole surgery).

A battery is fitted in the lower part of the abdomen and is attached to the muscle. When the battery is switched on, the muscle tightens and closes the bottom of the anal canal and restores continence. When the battery is turned off, the muscle loosens and opens the bottom of the anal canal and allows you to go to the toilet. A small hand held device is given (the size of a mobile telephone) to turn the muscle on and off.

Why do I need an endoscopic stimulated graciloplasty?

This procedure is offered to patients who have been troubled by faecal incontinence for some time and sufficient for surgery to be considered to resolve the problem. You will have tried medical treatments such as medication and physiotherapy before moving on to surgical treatments.

Surgical options for your problem are an Ileostomy or Colostomy with more specialist options of a Sphincter Repair, Sacral Nerve Neuromodulation and Endoscopic Stimulated Graciloplasty. Other surgical options may be available and these would have been suggested to you by your doctor or healthcare professional.

If you need any further information on the other options, you should contact your healthcare professional for further information. You should always remember that you can choose not to have surgery and stay as you are.

Can there be any complications or risks?

The most common risks of this procedure are bleeding, infection and constipation. You will be given antibiotics to resolve any infection. Bleeding will be treated while in hospital and to avoid constipation you will be given laxatives. This might make your incontinence worse following the procedure until you stop taking the laxatives which may be a few weeks following your procedure.

The muscle is usually moved endoscopically using keyhole surgery using a small incision at the knee and inside the groin. Occasionally, if this is not possible, the muscle will need to be moved using a long cut from the groin to the knee, this will only be known at the time of operation. The muscle can be tight for the first few months. This happens in 5% of patients.

If this happens, it may be necessary to perform an ileostomy operation (this is where the bowel is brought out through the skin and faecal waste is collected into a bag attached to the skin). Once the muscle settles down, the ileostomy would be reversed (the end of the bowel that was brought out of the skin is put back inside the body and repaired).

How do I prepare for the endoscopic stimulated graciloplasty?

Please read the information leaflet. Share the information it contains with your partner and family (if you wish) so that they can be of help and support. There may be information they need to know, especially if they are taking care of you following this procedure.

There is nothing special you have to do before the procedure. You will be given a date to attend the hospital for a pre-assessment. This is when a healthcare professional will assess you in preparation for the procedure. You will be asked questions and may have swabs or samples of blood taken. You may be asked to stop medication you take but this is to be done only under their instruction.

You will need to bring to hospital with you night clothes, slippers, toiletries and anything special you use on a daily basis.

How long will I be in hospital?

Patients are usually in hospital for approximately five to seven days. The length of stay will depend on how you have recovered and when your wounds drains have been removed.

What will happen?

You will be told either at your pre-assessment appointment or in your admission letter where you should report to and at what time. This may be on the day of your operation or the day before.

You will be seen on the ward by the anaesthetic and surgical team. This is a good time to ask any further questions or queries. They will also take your consent.

You will have a general anaesthetic which means you will be asleep for the procedure. The procedure takes approximately two and a half hours and you will stay in the theatre recovery area until they are happy for you to be transferred back to the ward.

You may wake up with a drip in your arm (tube leading from a bottle of fluid into one of your veins) and drains (tubes leading away from your wounds to drain away any fluid collections).

What happens afterwards?

Over the next few days you will have time to recover. Pain relief will be given to reduce any pain you have but you will feel some discomfort/pain for a few weeks following the procedure.

At this time, your new muscle is not working. It is necessary to retrain the muscle from one that tires easily to one that does not. To train this muscle, there will be a number of visits to the hospital starting at five to six weeks following your procedure and for five further visits until the muscle will be working fully. Only at this time will you know how successful the procedure has been.

The success rate of this procedure at the Hull and East Yorkshire Hospitals NHS Trust is approximately 70% of patients with a satisfactory result. This means that 30% of patients did not have a satisfactory result.

You may need to take approximately twelve weeks away from work. This is dependent on the individual and how quickly you recover. Once fully healed, you should not be restricted from working, sporting activities etc.

The battery used to close the muscle has a life of approximately five years. After five years, it would then need to be replaced. This procedure will only involve taking out the old battery in the abdomen and replacing it, the muscle will not be touched.

Should you require further advice on the issues contained in this leaflet, please do not hesitate to contact the GI Physiology Department on telephone (01482) 622130.

General Advice and Consent

Most of your questions should have been answered by this leaflet, but remember that this is only a starting point for discussion with the healthcare team.

Consent to treatment

Before any doctor, nurse or therapist examines or treats you, they must seek your consent or permission. In order to make a decision, you need to have information from health professionals about the treatment or investigation which is being offered to you. You should always ask them more questions if you do not understand or if you want more information.

The information you receive should be about your condition, the alternatives available to you, and whether it carries risks as well as the benefits. What is important is that your consent is genuine or valid. That means:

  • you must be able to give your consent
  • you must be given enough information to enable you to make a decision
  • you must be acting under your own free will and not under the strong influence of another person

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