{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T02:57:27Z","timestamp":1783652247576,"version":"3.55.0"},"reference-count":24,"publisher":"SAGE Publications","issue":"3","license":[{"start":{"date-parts":[[2018,12,14]],"date-time":"2018-12-14T00:00:00Z","timestamp":1544745600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Surg Innov"],"published-print":{"date-parts":[[2019,6]]},"abstract":"<jats:p>\n                    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\n                    <jats:sup>2<\/jats:sup>\n                    )\n                    <jats:sup>\u22121<\/jats:sup>\n                    , was calculated using the equation Tm = P(r\n                    <jats:sub>i<\/jats:sub>\n                    )(tm)\n                    <jats:sup>\u22121<\/jats:sup>\n                    , where P is the average maximum squeeze pressure and r\n                    <jats:sub>i<\/jats:sub>\n                    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\n                    <jats:sub>i<\/jats:sub>\n                    (12.4 [11.5-13.4] vs 18.7 [17.3-19.6] mm; P &lt; .001) resulted in an increase in Tm (233.2 [123.8-303.2] vs 490.8 [286.9-562.4] mN(cm\n                    <jats:sup>2<\/jats:sup>\n                    )\n                    <jats:sup>\u22121<\/jats:sup>\n                    ; P &lt; .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 &lt; .0001), and American Medical Systems score (39-point median decrease; P &lt; .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\n                    <jats:sub>i<\/jats:sub>\n                    , with consequent increase in Tm (length-tension relationship). Further studies are needed to confirm the long-term effectiveness of GK.\n                  <\/jats:p>","DOI":"10.1177\/1553350618818924","type":"journal-article","created":{"date-parts":[[2018,12,14]],"date-time":"2018-12-14T11:50:52Z","timestamp":1544788252000},"page":"321-327","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":18,"title":["Gatekeeper Improves Voluntary Contractility in Patients With Fecal Incontinence"],"prefix":"10.1177","volume":"26","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5372-2873","authenticated-orcid":false,"given":"Ugo","family":"Grossi","sequence":"first","affiliation":[{"name":"Proctology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Veronica","family":"De Simone","sequence":"additional","affiliation":[{"name":"Proctology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angelo","family":"Parello","sequence":"additional","affiliation":[{"name":"Proctology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Litta","sequence":"additional","affiliation":[{"name":"Proctology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lorenza","family":"Donisi","sequence":"additional","affiliation":[{"name":"Proctology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gian Luca","family":"Di Tanna","sequence":"additional","affiliation":[{"name":"Universitat de Barcelona, Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marta","family":"Goglia","sequence":"additional","affiliation":[{"name":"Proctology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0556-0037","authenticated-orcid":false,"given":"Carlo","family":"Ratto","sequence":"additional","affiliation":[{"name":"Proctology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy"},{"name":"Universit\u00e0 Cattolica del Sacro Cuore, Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2018,12,14]]},"reference":[{"key":"bibr1-1553350618818924","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2009.04.054"},{"key":"bibr2-1553350618818924","doi-asserted-by":"publisher","DOI":"10.1016\/j.cgh.2013.07.020"},{"key":"bibr3-1553350618818924","doi-asserted-by":"publisher","DOI":"10.1038\/ajg.2014.396"},{"key":"bibr4-1553350618818924","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM198405173102003"},{"key":"bibr5-1553350618818924","doi-asserted-by":"publisher","DOI":"10.1111\/nmo.12858"},{"key":"bibr6-1553350618818924","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199312233292601"},{"key":"bibr7-1553350618818924","doi-asserted-by":"publisher","DOI":"10.1111\/j.1572-0241.2006.00596.x"},{"key":"bibr8-1553350618818924","doi-asserted-by":"publisher","DOI":"10.1152\/ajpgi.00033.2008"},{"key":"bibr9-1553350618818924","doi-asserted-by":"publisher","DOI":"10.1097\/DCR.0b013e31822d0333"},{"key":"bibr10-1553350618818924","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(99)05218-6"},{"key":"bibr11-1553350618818924","doi-asserted-by":"publisher","DOI":"10.1002\/bjs.7699"},{"key":"bibr12-1553350618818924","doi-asserted-by":"publisher","DOI":"10.1002\/bjs.10050"},{"key":"bibr13-1553350618818924","doi-asserted-by":"publisher","DOI":"10.1007\/s10151-017-1723-8"},{"key":"bibr14-1553350618818924","doi-asserted-by":"publisher","DOI":"10.1007\/BF02050307"},{"key":"bibr15-1553350618818924","doi-asserted-by":"publisher","DOI":"10.1136\/gut.44.1.77"},{"key":"bibr16-1553350618818924","volume-title":"Fecal Incontinence Scoring System","author":"American Medical Systems","year":"1996"},{"key":"bibr17-1553350618818924","doi-asserted-by":"publisher","DOI":"10.1007\/BF02237236"},{"key":"bibr18-1553350618818924","doi-asserted-by":"publisher","DOI":"10.1007\/s10350-004-0774-x"},{"key":"bibr19-1553350618818924","doi-asserted-by":"publisher","DOI":"10.1007\/s12529-013-9368-0"},{"key":"bibr20-1553350618818924","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2982.2010.01608.x"},{"key":"bibr21-1553350618818924","doi-asserted-by":"publisher","DOI":"10.1007\/s10151-015-1396-0"},{"key":"bibr22-1553350618818924","doi-asserted-by":"publisher","DOI":"10.1097\/DCR.0b013e3182a18e87"},{"key":"bibr23-1553350618818924","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(94)92213-6"},{"key":"bibr24-1553350618818924","doi-asserted-by":"publisher","DOI":"10.1152\/ajpgi.00450.2013"}],"container-title":["Surgical Innovation"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/1553350618818924","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/1553350618818924","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/1553350618818924","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,2]],"date-time":"2026-05-02T07:21:04Z","timestamp":1777706464000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/1553350618818924"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,12,14]]},"references-count":24,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2019,6]]}},"alternative-id":["10.1177\/1553350618818924"],"URL":"https:\/\/doi.org\/10.1177\/1553350618818924","relation":{},"ISSN":["1553-3506","1553-3514"],"issn-type":[{"value":"1553-3506","type":"print"},{"value":"1553-3514","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,12,14]]}}}