Читать книгу Pathy's Principles and Practice of Geriatric Medicine - Группа авторов - Страница 500

The creation of a neosphincter using transplanted muscle may be considered in more severe faecal incontinence when other approaches have failed. Autologous muscle, usually gracilis or gluteus maximus, is transposed to form a new sphincter. The technique is limited by the physiology of the transposed muscle; the native anal sphincter is tonically contracted without effort, whereas the neosphincter requires conscious input to contract. In addition, the gracilis and gluteus maximus are largely type II fast‐twitch fibres, and the external anal sphincter consists of type I slow‐twitch, fatigue‐resistant fibres. These limitations can be overcome with electrical stimulation of the neosphincter, but the procedure has largely been superseded by sacral neuromodulation.⁵⁴