Smooth muscle sphincteroplasty in colostomy.
OBJECTIVE
The present work elaborated on Schmidt's idea of an effective smooth muscle sphincteroplasty. The aim of the study was to analyze the effects on the patients with a lower quadrant colostomy constructed after abdominoperineal extirpation of a modified smooth muscle sphincteroplasty combined with colon irrigations.


METHODS
Seventy-two rectal cancer patients (39 men and 33 women, median age, 54.5 years) with smooth muscle sphincteroplasty and 20 controls with conventional colostomy using colon irrigations (11 men and 9 women, median age, 63.2 years) were examined. A modified smooth muscle wrap of the colostomy with a free graft of a 4-cm-long colon segment without mucosa was applied. In this precolostomy segment a high intraluminal pressure was achieved. The functional capacity and anatomic integrity of the transplanted smooth muscle graft were examined manometrically, electromyographically, and histomorphologically. The functional activity of the colostomy was assessed by periodic recording of the number of "spontaneous" and "directed" defecations.RESULTS. In the patients with smooth muscle sphincteroplasty, the basal intraluminal pressure of the precolostomy segment two years after operation measured 29.7 mmHg. After dilatation of the transplant, these pressures reached up to 43 mmHg ( P < 0.001). The weekly "spontaneous" stools were 3 to 5 times less frequent than in the controls ( P < 0.001).


CONCLUSIONS
The modified smooth muscle sphincteroplasty offers operative-technical opportunities for increasing intraluminal pressure in the precolostomy colon segment. Its combination with colonic irrigations facilitates control of the evacuatory rhythm and "spontaneous" stools in colostomy patients, thus improving their quality of life.
Kostov
Daniel V
DV
Department of Surgery, Naval Hospital of Varna, Varna, Bulgaria. danielkostov@abv.bg
Temelkov
Temelko D
TD
Dragnev
Nedyalko A
NA
Kobakov
Georgi L
GL
Ivanov
Krasimir D
KD
D000328:Adult; D001003:Anal Canal / Q000473:pathology / Q000601:surgery*; D003125:Colostomy / Q000009:adverse effects*; D005242:Fecal Incontinence / Q000209:etiology / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009130:Muscle, Smooth / Q000601:surgery*; D007507:Therapeutic Irrigation; D016896:Treatment Outcome