ESGN stands for Electrically Stimulated Gracilis Neosphincter. This pioneering operation involves taking one of the hamstring muscles (gracilis) from the inner thigh, with its nerve and blood supply still intact, and wrapping this muscle around the anus to create a new sphincter (neosphincter). A stimulating electrode is then placed on the nerve to the muscle, and with the use of an insulated wire tunnelled under the skin, connects to a stimulator implanted under the skin of the abdominal wall. The stimulator has its own battery that lasts for years and through an external handheld set (much like a television remote control); the patient can turn on or off the stimulator. When turned on, the stimulator will send impulses to the electrode controlling the nerve to instruct the gracilis neosphincter to contract. This helps the patient to defer the urge to defecate until it is more convenient to visit the toilet where the stimulator can be turned off.
This operation was devised and developed by Professor Norman Williams, and gained NICE approval in 2006.
Why are we doing it?
Most often the result of injuries sustained during childbirth or an accident which has caused trauma to the pelvic region, and sometimes as a consequence of anal surgery, patients find themselves unable to resist the urge to defecate (faecal incontinence). This is an extremely disabling condition, resulting in fear being in social situations or even venturing out of the house. The impact on people’s mental and emotional health can be devastating. For a proportion of people who have no other choice, the ESGN procedure is the only way that they will avoid life with a permanent colostomy.
Professor Williams has pioneered and refined this technique over the last 20 years, over which time he has treated some 180 patients. The ESGN procedure is now a lifeline for the proportion of patients who respond poorly to Sacral Nerve Stimulation, which has been found in recent years to help patients to regain continence. In the UK it is practiced by Mr David Bartolo in Edinburgh and Mr Graeme Duthie in Hull. Worldwide it is in use as far afield as Tokyo, Japan.