Total anorectal reconstruction--fact or fiction.
Continuous electrical stimulation of a transposed gracilis muscle around an anatomically intact, but not functioning anus, proved to give a good continence even after many years. The procedure of pull through the colon and creation of a neo anus is indicated for a limited group of patients after Miles resection, trauma and atresia patients. In a series of 21 patients with abdomino-perineal pull through and the construction of a neo anus with a double dynamic graciloplasty, there was an enormous difference between the patients who underwent this reconstruction in the same operation as the abdomino-perineal resection (n = 14) and the patients who had the pull through several years after the Miles resection (n = 7). Reasonable continence was achieved in 8 out of the primary 14 operated patients and only 3 out of the 7 secondary operated patients. We can conclude that creation of a complete neo anus after a pull through is technically possible, and will result in an acceptable continence in about half the patients. Quality of continence will never be the same as in patients with a normal anatomical anus due to lack of sensibility.
Baeten
C G
CG
Department of Surgery, University Hospital Maastricht.
Rongen
M J
MJ
D000328:Adult; D001003:Anal Canal / Q000601:surgery*; D006801:Humans; D016737:Proctocolectomy, Restorative / Q000009:adverse effects / Q000379:methods*; D012002:Rectal Diseases / Q000601:surgery*; D012007:Rectum / Q000293:injuries / Q000601:surgery*; D016896:Treatment Outcome