title: Continent perineal colostomy by transposition of gracilis muscles. Technical remarks and results in 14 cases.
abstract: We herein present a study conducted on 14 patients presenting cancer of the lower rectum or of the anal canal (10 adenocarcinomas and 4 squamous-cell carcinomas) and submitted to the Miles abdominal perineal resection in which a new perineal sphincter was constructed.
  
  
  OBJECTIVE
  The aim of this study was to evaluate the efficacy of this new perineal sphincter constructed by transposing the gracilis muscles around an orthotopic colostomy in the attempt to avoid a permanent abdominal colostomy.
  
  
  METHODS
  In all cases both gracilis muscles were employed. The right one was placed along the posterior wall of the pelvis and fixed to the contralateral ischiatic tuberosity, creating a sling comparable to the levator ani muscles. The left gracilis was passed around the colon and attached to the ipsilateral or contralateral tuberosity according to its length, reconstructing a muscular ring. The entire procedure was performed in one step in nine cases and in more steps in the remaining five.
  
  
  RESULTS
  Of the 14 operated patients, 2 died of vascular disease and 1 developed necrosis of the colonic stump which required reconversion to an abdominal colostomy. Of the remaining 11 patients available for long-term evaluations, 8 showed adequate stool control. The remaining three manifested an incomplete level of continence. During the three-year follow-up period, all patients were evaluated by clinical examination, defecography, endoluminal ultrasonography, nuclear magnetic resonance, CT scan, and endoluminal manometry.
  
  
  CONCLUSIONS
  This neosphincter realizes an elastic stenosis responsible for an efficient level of continence. Best results are observed in the young and educated patients submitted to surgery in two steps. Contraindications to this surgery seem to be advanced cancer, old age, and obesity.
authors.affiliation: Cancer Institute Regina Elena, II Department of Surgical Oncology, Rome, Italy.
authors.forename: E
authors.initials: E
authors.lastname: Santoro
authors.forename: C
authors.initials: C
authors.lastname: Tirelli
authors.forename: F
authors.initials: F
authors.lastname: Scutari
authors.forename: A
authors.initials: A
authors.lastname: Garofalo
authors.forename: G
authors.initials: G
authors.lastname: Silecchia
authors.forename: M
authors.initials: M
authors.lastname: Scaccia
authors.forename: E
authors.initials: E
authors.lastname: Santoro
mesh_terms: D000230:Adenocarcinoma / Q000601:surgery; D000328:Adult; D000368:Aged; D001005:Anus Neoplasms / Q000601:surgery; D002294:Carcinoma, Squamous Cell / Q000601:surgery; D003125:Colostomy / Q000379:methods*; D003672:Defecation; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010502:Perineum / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D011183:Postoperative Complications; D011859:Radiography; D012004:Rectal Neoplasms / Q000601:surgery; D013524:Surgical Flaps / Q000379:methods*; D014463:Ultrasonography