Free Antropyloric Valve Flap for End-Stage Fecal Incontinence as a Substitute to Permanent Colostomy

Area of Science:

• Surgical reconstruction techniques
• Gastrointestinal surgery
• Vascular anatomy

Background:

• Anal cancer surgery often results in end-stage fecal incontinence (ESFI), necessitating a permanent colostomy and significantly impacting quality of life.
• Current treatment options for ESFI are limited.
• Pedicled antropyloric valve (APV) flaps have been described but can be risky and difficult to perform due to long omental pedicles.

Observation:

• Bench dissections revealed consistent right gastroepiploic and infrapyloric vessels suitable for a free APV flap.
• A free APV flap, including a vagus nerve branch, was successfully harvested with minimal dissection.
• Tension-free anastomosis was achieved between the epiploic and left colic vessels in a patient where pedicled transposition was not feasible.

Findings:

• The free APV flap demonstrated good survival and tone, confirmed by radiological and manometric evaluation.
• Vascular anatomy supports the technical feasibility of harvesting a free APV flap.
• The procedure was successfully applied in a clinical case where a pedicled flap was not an option.

Implications:

• Free APV flap transposition is a technically feasible and advantageous option for treating ESFI.
• This technique offers a potential alternative to permanent colostomy for patients with anal cancer.
• The free APV flap has the potential to become a popular and effective solution for ESFI.