title: 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.
authors.affiliation: Ludwig Boltzmann Institute for Surgical Oncology, Donauspital/SMZ-Ost, Wien, Austria.
authors.forename: H. R
authors.initials: HR
authors.lastname: Rosen
authors.forename: C
authors.initials: C
authors.lastname: Urbarz
authors.forename: G
authors.initials: G
authors.lastname: Novi
authors.forename: G
authors.initials: G
authors.lastname: Zöch
authors.forename: R
authors.initials: R
authors.lastname: Schiessel