Electrostimulation Technique

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Electrostimulation can be started 2-4 weeks after the operation, when the perineal wounds have healed and the gracilis tendon is firmly sealed to the ischiat-ic bone. The electrical parameters can be programmed by a portable tele-neuroprogrammer (N-vision MEDTRONIC) according to two different protocols [25].

a. Continuous electrostimulation: impulse width 210 ms, minimum voltage required for the full muscle contraction, increased frequency from 2 Hz for the first and second week, to 5 Hz for the third and fourth week, to 10 Hz for the fifth and sixth week, then 15 Hz indefinitely (24 h a day).

b. Cyclic electrostimulation: impulse width 210 ms, minimum voltage required for the full muscle contraction, fixed frequency of 15 Hz, ON period of 2 s and OFF period of 6 s in the first 2 weeks, ON period of 2 s and OFF period of 4 s during the third and fourth weeks, ON period of 4 s and OFF period of 4 s during the fifth and sixth weeks, ON period of 4 s and OFF period of 2 s during the seventh and eighth weeks, permanently ON (24 h a day) thereafter.

Both methods of electrostimulation have been shown to be effective in inducing a fast-to-slow muscle conversion in an experimental study on rabbits [25]. After the muscle conversion to a fatigue-resist-

Table 1. Outcome after total anorectal reconstruction with dynamic (electrostimulated) gracilis neo-sphincter

Authors Year Patients Success % Procedure

Seccia et al. [12]

1994

9

Mander et al. [13]

1996

12

Geerdes et al. [14]

1997

15

Altomare et al. [15]

1997

4

Rosen et al. [16]

1998

18

Violi et al. [18]

2004

16

Ho, Seow-Choen [17]

2005

17

ant muscle is completed, the patient is provided with a remote control device (portable tele-programmer mod. 3031, Medtronic Inc., Minneapolis) and instructed to switch the IPG OFF when he/she feels the stimulus to evacuate and switch it ON again at the end of defecation. The remote control device also enables the patient to increase or decrease the voltage within a programmed range.

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