Background. Gatekeeper (GK) has shown to be safe and effective in patients with fecal incontinence (FI). We aimed to understand its mechanism of action by comparing pre- and post-implant change in the external anal sphincter (EAS) contractility. Methods. Study of EAS contractility was conducted in 16 FI females (median age = 69 years) before and after implant of 6 GK prostheses. Muscle tension (Tm), expressed in millinewtons per centimeter squared, mN(cm(2))(-1), was calculated using the equation Tm = P(r(i))(tm)(-1), where P is the average maximum squeeze pressure and r(i) and tm the inner radius and thickness of the EAS, respectively. The effect of a predefined set of covariates on Tm was tested by restricted maximum likelihood models. Results. Compared with baseline, despite unchanged tm (2.7 [2.5-2.8] vs 2.5 [2.2-2.8] mm; P = .31 mm), a significant increase in P (median = 45.8 [26.5-75.8] vs 60.4 [43.1-88.1] mm Hg; P = .017), and r(i) (12.4 [11.5-13.4] vs 18.7 [17.3-19.6] mm; P < .001) resulted in an increase in Tm (233.2 [123.8-303.2] vs 490.8 [286.9-562.4] mN(cm(2))(-1); P < .001) at 12 months after GK implant. Twelve-month follow-up improvements were also observed on Cleveland Clinic FI score (8-point median decrease; P = .0001), St Marks FI score (10-point median decrease; P < .0001), and American Medical Systems score (39-point median decrease; P < .0001). Restricted maximum likelihood models showed that years of onset of FI was negatively associated with change in Tm (P = .048). Conclusions. GK-related EAS compression positively influences muscle contractility by increasing r(i), with consequent increase in Tm (length-tension relationship). Further studies are needed to confirm the long-term effectiveness of GK.

Gatekeeper Improves Voluntary Contractility in Patients With Fecal Incontinence / Grossi MD1, Ugo; De Simone MD1, Veronica; Parello MD1, Angelo; Litta MD1, Francesco; Donisi MD1, Lorenza; Luca Di Tanna MD1, Gian; Goglia, Marta; Carlo Ratto MD, And. - In: SURGICAL INNOVATION. - ISSN 1553-3506. - 26:3(2019), pp. 321-327. [10.1177/1553350618818924]

Gatekeeper Improves Voluntary Contractility in Patients With Fecal Incontinence

Marta Goglia;
2019

Abstract

Background. Gatekeeper (GK) has shown to be safe and effective in patients with fecal incontinence (FI). We aimed to understand its mechanism of action by comparing pre- and post-implant change in the external anal sphincter (EAS) contractility. Methods. Study of EAS contractility was conducted in 16 FI females (median age = 69 years) before and after implant of 6 GK prostheses. Muscle tension (Tm), expressed in millinewtons per centimeter squared, mN(cm(2))(-1), was calculated using the equation Tm = P(r(i))(tm)(-1), where P is the average maximum squeeze pressure and r(i) and tm the inner radius and thickness of the EAS, respectively. The effect of a predefined set of covariates on Tm was tested by restricted maximum likelihood models. Results. Compared with baseline, despite unchanged tm (2.7 [2.5-2.8] vs 2.5 [2.2-2.8] mm; P = .31 mm), a significant increase in P (median = 45.8 [26.5-75.8] vs 60.4 [43.1-88.1] mm Hg; P = .017), and r(i) (12.4 [11.5-13.4] vs 18.7 [17.3-19.6] mm; P < .001) resulted in an increase in Tm (233.2 [123.8-303.2] vs 490.8 [286.9-562.4] mN(cm(2))(-1); P < .001) at 12 months after GK implant. Twelve-month follow-up improvements were also observed on Cleveland Clinic FI score (8-point median decrease; P = .0001), St Marks FI score (10-point median decrease; P < .0001), and American Medical Systems score (39-point median decrease; P < .0001). Restricted maximum likelihood models showed that years of onset of FI was negatively associated with change in Tm (P = .048). Conclusions. GK-related EAS compression positively influences muscle contractility by increasing r(i), with consequent increase in Tm (length-tension relationship). Further studies are needed to confirm the long-term effectiveness of GK.
2019
gatekeeper; fecal incontinence; external anal sphincter; length-tension relationship; mechanism of action
01 Pubblicazione su rivista::01a Articolo in rivista
Gatekeeper Improves Voluntary Contractility in Patients With Fecal Incontinence / Grossi MD1, Ugo; De Simone MD1, Veronica; Parello MD1, Angelo; Litta MD1, Francesco; Donisi MD1, Lorenza; Luca Di Tanna MD1, Gian; Goglia, Marta; Carlo Ratto MD, And. - In: SURGICAL INNOVATION. - ISSN 1553-3506. - 26:3(2019), pp. 321-327. [10.1177/1553350618818924]
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11573/1560119
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