Long‐term results of modified graciloplasty for sphincter replacement after rectal excision

Abstract

OBJECTIVE: Restoration of the anal sphincter by means of electrically stimulated (dynamic) graciloplasty is a new therapeutic option for patients with severe faecal incontinence or those having abdomino-perineal resection (APR) of the anorectum. The present study reviews the outcome of total anorectal reconstruction (TAR) after APR for low rectal cancer or recurrent anal cancer. METHODS: From 1992 to 2000, 35 of 64 patients treated with dynamic graciloplasty had a TAR performed either synchronously (n=26) or as a secondary procedure one to five years after rectal excision (n = 9). RESULTS: The most frequent complication was injury or erosion of the neorectum (n = 9) which, was avoided with increasing surgical experience. Defaecation disorders and consequent incontinence were the most common functional problem and had to be treated with periodical enemas. CONCLUSION: Although sphincter replacement by means of TAR after APR led to poorer functional results than those achieved in patients treated with dynamic graciloplasty for faecal incontinence, TAR remains a valid treatment option for patients who do not tolerate a permanent stoma.

Laparoscopic or Transanal Repair of Rectocele? A Retrospective Matched Cohort Study

“…38 However, neither the degree of improvement nor patient satisfaction was reflected in the postoperative QOL scores. The QOL score did not predict a successful outcome in either cohort.…”

Evolving Therapy for Fecal Incontinence

“…98 It also has been used in total anorectal reconstruction after abdominoperineal resection for low rectal or recurrent anal cancers. 99,100 The gracilis muscle is mobilized, and its distal tendon is divided. The muscle is then wrapped around the anal canal, forming a gamma, epsilon, or alpha loop, depending on the anatomic configuration of the patient.…”

“…3 The results of dynamic graciloplasty have been variable (Table 4). Continence rates ranging from 35 to 85 percent [99][100][101][102][103][104][105][106][107][108][109][110][111][112][113][114][115] have been reported with more favorable results originating from centers with higher surgical volume. 109 Patients with congenital malformations tend to have a worse outcome than those with acquired anorectal dysfunction.…”

“…Koch et al 106 28 35 Mander et al 107 12 42 Mander et al 108 64 69 Penninckx et al 109 60 78 Rongen et al 110 200 72 Rosen et al 100 35 66 Rouanet et al 111 9 5 6 Rullier et al 112 12 58 Thornton et al 113 38 60 Wexner et al 114 115 62 Williams et al 115 20 60…”

Empfehlungen zu Diagnostik und multimodaler Primärtherapie des Rektumkarzinoms 2004

“…Auch eine EndSeit-Anastomose kann eine vergleichbare Funktionsverbesserung erzielen (Machado 2003) (Evidence-Level: 1). Im Fall einer abdominoperinealen Exstirpation kann entweder simultan oder zu einem späteren Zeitpunkt eine stimulierte Grazilisplastik angelegt werden, um die Ausscheidungsfunktion auf natürlichem Weg wiederherzustellen (Rosen 2002 …”