New rectal construction after abdominoperineal resection for carcinoma rectum

The results of the new reconstruction of the rectum after Abdominoperineal Resection (APR) with 'S'-trap arrangement of the colon and continent perineal colostomy controlled by adynamic bilateral graciloplasty are evaluated. The fully stretched gracilis muscles were utilized for occlusion of the lumen of the colon.

Between April 1993 and December 2006, selected 42 patients (30 males and 12 females) with median age of 43.5 years (25-64 years) were treated by a one-stage procedure without colonic diversion. All patients were suffering from adenocarcinoma of the lower third of the rectum. The abdominoperineal resection was carried out in all cases. A 25-cm-long vascular segment of the colon was installed in the sacral curve and 'S'-shaped trap was developed with fixed colonic curves at the coccyx and to the left ischial rami of the pubic bone. The left gracilis was wrapped around just distal to the fixed curve of the colon to the left ischial rami and right one around the perineal colostomy with different grades of tightness. Continence was satisfactory in 34 patients; they could hold more than 1,000 ml of saline. Occasional soiling was reported in the night in 8 patients. All patients have achieved near-natural continence. The new rectal reconstruction with 'S' arrangement of colon and continent perineal colostomy achieved near-natural continence in 66% of cases.