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Total anorectal reconstruction--fact or fiction
1Department of Surgery, University Hospital Maastricht.
Swiss Surgery = Schweizer Chirurgie = Chirurgie Suisse = Chirurgia Svizzera
|January 1, 1997
Summary
Electrical stimulation of a transposed gracilis muscle can create a functional neo-anus, offering good continence for select patients. Early reconstruction after Miles resection yields better results than delayed procedures.
Area of Science:
- Colorectal Surgery
- Reconstructive Surgery
- Pelvic Floor Rehabilitation
Background:
- Anoplasty reconstruction is challenging after abdominoperineal resection, trauma, or atresia.
- Dynamic graciloplasty with electrical stimulation offers a potential solution for fecal incontinence.
Purpose of the Study:
- To evaluate the efficacy of dynamic graciloplasty with electrical stimulation for neo-anus creation.
- To compare outcomes between primary and secondary reconstructions following Miles resection.
Main Methods:
- A series of 21 patients underwent abdomino-perineal pull-through with double dynamic graciloplasty.
- Patients were divided into primary (n=14) and secondary (n=7) reconstruction groups.
- Continuous electrical stimulation was applied to the transposed gracilis muscle.
Main Results:
- Reasonable continence was achieved in 8/14 primary reconstruction patients.
- Continence was achieved in 3/7 secondary reconstruction patients.
- Overall, acceptable continence was achieved in approximately half of the patients.
Conclusions:
- Neo-anus creation via pull-through and dynamic graciloplasty is technically feasible.
- Primary reconstruction offers superior continence outcomes compared to secondary.
- Achieved continence is functional but lacks the sensory feedback of a normal anus.