PURPOSE:Graciloplasty has been used as a treatment for end‐stage fecal incontinence since 1946. Electric stimulation with an implantable pulse generator has existed for 15 years. The gracilis muscle is wrapped around the anal canal and stimulated by intramuscular electrodes connected with an implantable pulse generator. Initial reports have been promising, but long‐term results have not been presented to date.METHODS:Data of 200 consecutive patients with a follow‐up of at least two years were analyzed in a prospective manner from 1986 until 1999.RESULTS:The overall success rate was 72 percent. In patients with fecal incontinence caused by trauma, the rate was 82 percent. Once continent, patients remained continent after a median follow‐up of 261 (standard deviation, 132) weeks. Median survival of the implantable pulse generator until battery expiration was 405 weeks. Disturbed evacuation remained a problem in 16 percent of all patients. Complications were frequent but treatable.CONCLUSION:Dynamic graciloplasty is a good, cost‐effective treatment for fecal incontinence with results lasting for a median of more than five years.