Dynamic graciloplasty for total anorectal reconstruction after abdominoperineal resection for rectal tumour

To review the results of dynamic graciloplasty for total anorectal reconstruction after abdominoperineal resection (APR) for rectal cancer.

Chart reviews were done on 17 patients who had dynamic graciloplasty following abdominoperineal resection and details of post-operative complications, bowel functions and recurrences were obtained.

Seventeen patients (12 males) had dynamic graciloplasty after APR for low rectal tumours. The median age was 58.5 years (range 33-78). Three patients from overseas were lost to follow-up, and three still have not had the defunctioning stoma closed. Only 11 patients were available for evaluation of function. The median time from graciloplasty to continence to solids and liquids is 15.7 months (range 0.4-21.9 months). Six patients had defecatory problems, requiring daily irrigation to evacuate. Nine patients were continent without need for gracilis stimulation. Only two patients needed gracilis stimulation to maintain continence. Fifty percent of rectal carcinoma patients had developed a recurrence.

Dynamic graciloplasty had a high morbidity and did not always bring about normal defecatory function. Gracilis stimulation was not needed to achieve continence in all cases. Conversely, dynamic graciloplasty may lead to defecatory difficulties in a large number of patients. Graciloplasty should only be considered three years after the initial APR to avoid performing the procedure in a patient who may develop recurrence as well as to select patients who are psychologically prepared for the surgery and its complications.