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Anorectal reconstruction by electrostimulated graciloplasty as part of abdominoperineal resection
V Violi1, A S Boselli, M De Bernardinis
1Department of Surgical Sciences, General Surgery Clinic, University of Parma Medical School, Ospedale Maggiore, Via Gramsci 14, 43100 Parma, Italy. vincenzo.violi@unipr.it
Aims:
To report the outcomes of anorectal reconstruction by electrostimulated graciloplasty as part of abdominoperineal resection, on data prospectively collected over 10 years.
Patients And Methods:
Twenty-three abdominoperineal resections were associated to coloperineal pull through, double graciloplasty and loop abdominal stoma. Fifteen patients also received an implantable pulse generator, either for unsatisfactory result after external-source intermittent electrostimulation and biofeedback (five cases) or during graciloplasty (10 cases). Follow-up was to a maximum of 10 years. Functional outcome was followed up in sixteen patients who underwent stoma takedown.
Results:
Mean actuarial survival at 5 years was 72.3%. Satisfactory results (score < or =8) occurred in 75% of patients (three without and 13 with stimulator) in the early stages, decreasing to 57% at 1 year and gradually increasing up to 100% at 5 years and over.
Conclusions:
Total anorectal reconstruction yields a good functional outcome over time. Thus, despite, and because of, a high complication rate and a great drain on resources, it should be considered a suitable procedure only for selected, strongly motivated patients.
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