Department of Thoracic Surgery, Thoraxklinik Heidelberg University, Röntgenstraße 1, 69126, Heidelberg, Germany.
Department of Surgery, St. Josefskrankenhaus Heidelberg, Akademisches Lehrkrankenhaus der Medizinischen Fakultät Mannheim der Universität Heidelberg, Landhausstraße 25, 69115, Heidelberg, Germany.
Int J Colorectal Dis. 2021 Mar;36(3):569-580. doi: 10.1007/s00384-020-03825-2. Epub 2021 Jan 2.
Gracilis muscle transposition (GMT) is an established surgical technique in the treatment of anorectal fistulas and fistulas to the vagina and the urinary system when previous closure options have failed. There is little evidence on the success rate of this procedure in the long term.
This is a follow-up study on all patients undergoing GMT over a 10-year period at a tertiary referral center for complex fistulas. Postoperative function and quality of life were evaluated by standardized questionnaires (Wexner score, Fecal Incontinence Quality of Life Score (FIQL), SF-12 and a brief questionnaire designed for this study). Sexual function was evaluated by the Female Sexual Function Index (FSFI) and the International Index of Erectile Function.
Forty-seven gracilis muscle transpositions (GMT) in 46 patients were performed. Most treated patients had (neo-)-rectovaginal fistulas (n = 29). An overall fistula closure was achieved in 34 of 46 patients (74%): in 25 cases primarily by GMT (53%) and in nine patients with persistent or recurrent fistula by additional surgical procedures. A clinically apparent relapse occurred on average 276 days (median: 180 days) after GMT (mean follow-up 73.4 months).
GMT in our hands has a primary closure rate of 53%, and after further procedures, this rises to 74%. Fecal continence is impaired in patients having undergone GMT. The overall quality of life in patients after GMT is only slightly impaired, and sexual function is severely impaired in female patients.
内收肌转移术（GMT）是治疗直肠阴道瘘和阴道及泌尿系统瘘的一种成熟的手术技术，适用于先前的闭合方法失败的情况。关于该手术长期成功率的证据很少。
这是在一家复杂瘘管三级转诊中心对 10 年内接受 GMT 的所有患者进行的一项随访研究。通过标准化问卷（Wexner 评分、粪便失禁生活质量评分（FIQL）、SF-12 和为此研究设计的简短问卷）评估术后功能和生活质量。通过女性性功能指数（FSFI）和国际勃起功能指数评估性功能。
46 例患者中有 47 例接受了内收肌转移术（GMT）。大多数接受治疗的患者患有（新）直肠阴道瘘（n=29）。46 例患者中有 34 例（74%）实现了瘘管完全闭合：25 例主要通过 GMT 实现（53%），9 例持续性或复发性瘘管患者通过额外的手术治疗实现。GMT 后平均 276 天（中位数：180 天）出现临床明显复发（平均随访时间为 73.4 个月）。
在我们的手中，GMT 的初次闭合率为 53%，通过进一步的手术，这个比例上升到 74%。接受 GMT 治疗的患者的粪便控制能力受损。GMT 后患者的整体生活质量仅略有受损，女性患者的性功能严重受损。
