A new approach to dynamic graciloplasty.
The reestablishment of anal function by transposition of the gracilis muscle, combined with the implantation of electrodes and a neuromuscular stimulator (dynamic graciloplasty), has recently been developed. With this method, the transposed muscle maintains contraction by electrical stimulation to maintain neoanal pressure without fatigue. It is necessary to convert the fatigue-prone gracilis muscle to fatigue-resistant muscle by long-term electrical stimulation (conditioning). In most patients receiving dynamic graciloplasty, the conditioning is accomplished after the transposition. However, conditioning before graciloplasty should reduce the risk of ischemia in the transposed muscle after the graciloplasty and improve the outcome. This new sequence of procedures is described, in combination with J-pouch construction, in a patient who required abdominoperineal excision of the rectum for lower rectal cancer. The graciloplasty was performed after conditioning of the gracilis muscle in situ; the conditioning did not cause the patient discomfort and resulted in good anal function.
Shatari
T
T
Municipal Ida Hospital, Kawasaki City, Kawasaki, Japan.
Kawahara
H
H
Inoue
S
S
Sakurai
T
T
Kawachi
S
S
Teramoto
T
T
Kitajima
M
M
D000230:Adenocarcinoma / Q000601:surgery; D000328:Adult; D001003:Anal Canal / Q000601:surgery*; D003107:Colorectal Surgery / Q000379:methods; D006801:Humans; D008297:Male; D012004:Rectal Neoplasms / Q000601:surgery; D012086:Reoperation