Construction of a neorectum and neoanal sphincter following previous proctocolectomy.
A new operation is described in which a neorectum and neoanal sphincter mechanism have been constructed to restore gastrointestinal continuity and continence in a patient who had previously undergone proctocolectomy and a permanent ileostomy. The neorectum was constructed by forming a triplicated pouch from the distal ileum. The neoanal sphincter was fashioned from a transposed gracilis muscle and was activated electrically by an implanted stimulator. A period of chronic low frequency stimulation altered the muscle characteristics and enabled the neosphincter to contract continually without fatigue. Complete continence was achieved by the neosphincter gripping a Silastic plug inserted within the efferent spout of the pouch. The patient was able to void completely when the stimulator was switched off and the plug removed.
Williams
N S
NS
Surgical Unit, London Hospital Medical College, UK.
Hallan
R I
RI
Koeze
T H
TH
Watkins
E S
ES
D000328:Adult; D001003:Anal Canal / Q000502:physiology / Q000601:surgery*; D003082:Colectomy; D004558:Electric Stimulation; D004567:Electrodes, Implanted; D006801:Humans; D007081:Ileostomy; D007082:Ileum / Q000601:surgery; D008297:Male; D008722:Methods; D011183:Postoperative Complications; D012007:Rectum / Q000601:surgery*; D012086:Reoperation