title: Long-term outcomes of a neo-anus with a pudendal nerve anastomosis contemporaneously reconstructed with an abdominoperineal excision of the rectum.
abstract: BACKGROUND
  Pudendal nerve innervation can transform a neo-sphincter into an original anal sphincter-like muscle in animal studies. The results led us to clinical trials of a neo-anus with a pudendal nerve anastomosis (NAPNA). No long-term results in a series have been reported.
  
  
  METHODS
  From 1995 to 2003, a neo-anus was reconstructed by using an inferior portion of the gluteus maximum muscle with a pudendal nerve anastomosis contemporaneously with an abdominoperineal excision of the rectum (APER) in 19 patients (17 men, 2 women; median age, 62.0 years; range, 46-73) with low-lying malignancy. The long-term (<2 years) clinical results were evaluated.
  
  
  RESULTS
  The neo-sphincter began contracting (n = 15) at 6.6 +/- 1.8 months after surgery; then the ileostomy was closed (n = 14) at 9.1 +/- 2.6 months. The long-term results were studied in 10 patients (40.9 +/- 14.1 months after ileostomy closure). All patients (100%) defecated at 4.8 +/- 2.6 times/day without irrigation. Pads were used every day in 9 patients (90%). The Cleveland Clinic Florida incontinence score was 12.2 +/- 3.3 points. No patients lost their occupation. Eight patients (80%) answered that their life with a NAPNA was better than with an ileostomy. The average World Health Organization Quality of Life-BREF in patients with NAPNAs was significantly better than that in those patients who underwent conventional APERs in our hospital (n = 27, 66.4 +/- 0.8 years old) ( P = .0402). Four patients (40%) experiencing the need to defecate got significantly better continence score (mean +/- SD).
  
  
  CONCLUSIONS
  The sensitivity to recognize the need to defecate may be a key to success in NAPNAs. A NAPNA can be a practical option for selected patients wishing to avoid a stoma after an APER.
authors.affiliation: Department of Surgery, Jichi Medical School, 3311-1 Yakushiji, Minamikawachi-machi, Kawachi-gun, Tochigi-ken 329-0134, Japan.
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Sato
authors.forename: Fumio
authors.initials: F
authors.lastname: Konishi
authors.forename: Noriyuki
authors.initials: N
authors.lastname: Endoh
authors.forename: Hirokazu
authors.initials: H
authors.lastname: Uda
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Sugawara
authors.forename: Hideo
authors.initials: H
authors.lastname: Nagai
mesh_terms: D000367:Age Factors; D000368:Aged; D001003:Anal Canal / Q000294:innervation / Q000601:surgery*; D000714:Anastomosis, Surgical / Q000379:methods*; D003672:Defecation; D004651:Employment; D005260:Female; D005500:Follow-Up Studies; D046152:Gastrointestinal Stromal Tumors / Q000601:surgery*; D006801:Humans; D007902:Length of Stay; D008297:Male; D008365:Manometry; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000294:innervation / Q000601:surgery; D010502:Perineum / Q000294:innervation / Q000601:surgery; D010525:Peripheral Nerves / Q000601:surgery; D011788:Quality of Life; D019651:Plastic Surgery Procedures / Q000379:methods*; D012004:Rectal Neoplasms / Q000601:surgery*; D016896:Treatment Outcome