Reconstruction of an orthotopic functional anus after abdominoperineal resection

A case is reported of the reconstruction of a continent anus after an abdominoperineal resection for a patient who presented with a Dukes B adenocarcinoma at 4.5 cm from the anal verge. After a radical excision, the perineal colostomy was sited orthotopically. The right gracilis muscle, completely detached from the thigh except for the neurovascular pedicle, was wrapped around the neorectum at the original level of the levator ani, in an alpha loop configuration. The free ends of the alpha loop pointing anteriorly were sutured to the public bone. Thus the 80 degrees ano-rectal angle was reconstructed. A temporary transverse colostomy was also performed. After closure of the colostomy at eight weeks, the patient was immediately continent of soft stools without a learning period. Pressure studies of the new sphincter are also reported.