An innovative model of autologous anorectal transplantation with pudendal nerve reconstruction

Galvão, Flávio Henrique Ferreira; Seid, Víctor Edmond; Waisberg, Daniel Reis; Cruz-Jr, Ruy Jorge; Hirano, Hugo Kenji Matsushima; Catanozi, Sérgio; Chaib, Eleazar; D’Albuquerque, Luiz Augusto Carneiro

doi:10.6061/clinics/2012(08)20

Cited by 13 publications

(18 citation statements)

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“…In that study, the anorectum from female pigs was transplanted into male pigs without immunosuppression and successful inferior mesenteric artery (IMA), inferior mesenteric vein (IMV), and pudendal nerve (PN) anastomoses were achieved. Since then, similar experimental studies have been reported using rat [8–10], swine [11], and canine models [12]. However, no reports currently exist in the literature examining the possibility of anorectal transplantation in humans.…”

Section: Introductionmentioning

confidence: 83%

Anorectal Transplantation in Human Cadavers: Mock Anorectal Allotransplantation

Araki

Sato²,

Naito

et al. 2013

PLoS ONE

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BackgroundAnorectal transplantation is a method for patients who have lost their anorectal function or suffer from congenital anorectal dysfunction to recover this function, and this has been investigated in experimental animal models using pigs, dogs, and rats. In this study, we performed an examination of anorectal transplantation in human cadavers to investigate whether this procedure could be performed in patients.MethodsA 77-year-old woman cadaver 1 was used as the donor and a 98-year-old woman cadaver 2 was used as the recipient. Initially, abdominoperineal excision of the anus and rectum (the Miles’ operation) was performed on the recipient. Next, an anorectal graft containing the pudendal nerve (PN), pudendal artery (PA), pudendal vein (PV), inferior mesenteric artery (IMA), and inferior mesenteric vein (IMV) was harvested from the donor. The donor graft was transplanted into the recipient by intestinal anastomosis and microneurovascular anastomoses orthotopically.ResultsThe diameters of the PN (right/left), IMA, and IMV were 2.5 mm/2.5 mm, 2.0 mm, and 1.5 mm, respectively, in cadaver 1, and 2.0 mm/2.0 mm, 2.0 mm, and 2.0 mm, respectively, in cadaver 2. The length of the PN, PA, PV, IMA, and IMV in the graft was sufficient to allow proper anastomosis.ConclusionThis preliminary study indicated that human anorectal transplantation was possible anatomically and technically. We anticipate our study will aid in the potential future application of this procedure to human patients.

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Section: Introductionmentioning

confidence: 83%

Anorectal Transplantation in Human Cadavers: Mock Anorectal Allotransplantation

Araki

Sato²,

Naito

et al. 2013

PLoS ONE

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“…Further, they succeeded in swine anorectal autotransplantation by anastomoses between the IMA and the aorta, the IMV and vena cava, and the PNs. No problems regarding graft perfusion were histologically observed two hours postoperatively19. We also tried to establish a canine anal autotransplantation model by anastomoses of the IMA, the IMV, and the PNs; however, this failed because of graft necrosis due to blood flow disorder20.…”

Section: Discussionmentioning

confidence: 99%

Anorectal autotransplantation in a canine model: the first successful report in the short term with the non-laparotomy approach

Araki

Nakamura

Sato³

et al. 2014

Sci Rep

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Colostomy is conventional treatment for anal dysfunction. Recently, a few trials of anorectal transplantation in animals have been published as a potential alternative to colostomies; however, further development of this technique is required. In this study, we utilized a canine model of anorectal transplantation, evaluated the patency of our microsurgical anastomoses, and assessed the perfusion of the transplanted anus. We designed a canine anorectal transplantation model, wherein anorectal autotransplantation was performed in four healthy beagle dogs by anastomoses of the lower rectum, the bilateral pudendal arteries (PAs) and veins (PVs), and pudendal nerves (PNs). Postoperative graft perfusion was measured by indocyanine green (ICG) angiography and histological examination. The length of the anorectal graft including perianal skin, anal sphincter muscle, bilateral PAs, PVs, and PNs was 4.9 ± 0.3 cm. All diameters of the PAs, PVs, and PNs were large enough to be microscopically anastomosed. Both ICG angiography and histological examination demonstrated good graft perfusion, except for one case that lead to venous congestion. These results show that anastomosis of the bilateral PAs, PVs, and PNs is required for anorectal transplantation. This is the first successful report of canine anorectal autotransplantation.

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“…The technical feasibility of anorectal transplantation in porcine, canine and rat models has been reported, but functional outcomes are unclear. The authors' group has previously described autologous orthotopic and heterotopic anorectal transplantation rat models.…”

Section: Introductionmentioning

confidence: 99%

Functional outcome of autologous anorectal transplantation in an experimental model

Seid

Galvão

Vaidya

et al. 2015

British Journal of Surgery

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Orthotopic anorectal transplantation may result in better functional outcomes than heterotopic procedures. Surgical relevance Patients with a permanent colostomy have limited continence. Treatment options are available, but anorectal transplantation may offer hope. Some experimental studies have been conducted, but available data are currently insufficient to translate into a clinical option. This paper details functional outcomes in a rat model of anorectal autotransplantation. It represents a step in the translational research that may lead to restoration of anorectal function in patients who have lost or have failed to develop it.

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An innovative model of autologous anorectal transplantation with pudendal nerve reconstruction

Cited by 13 publications

References 5 publications

Anorectal Transplantation in Human Cadavers: Mock Anorectal Allotransplantation

Anorectal Transplantation in Human Cadavers: Mock Anorectal Allotransplantation

Anorectal autotransplantation in a canine model: the first successful report in the short term with the non-laparotomy approach

Functional outcome of autologous anorectal transplantation in an experimental model

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