title: Secondary implantation of an artificial sphincter after abdominoperineal resection and pseudocontinent perineal colostomy for rectal cancer.
abstract: BACKGROUND
  Fecal continence with a perineal colostomy performed after abdominoperineal resection (APR) is not always satisfactory despite retrograde colonic enemas. Functional improvement is currently examined using artificial sphincters. Preliminary results are disclosed.
  
  
  METHODS
  In 3 female patients, 45, 59 and 68 years old, curative APR and perineal colostomy were performed after radiotherapy in 2, for T1-2N0 cancer of the lower rectum. Due to occasional leaks, need for strict diet and fear of incontinence, an Acticon Neosphincter (AMS) was implanted consecutively at a mean 4.5 years after APR.
  
  
  RESULTS
  Device implantation was feasible and uneventful. In one case, a superficial hematoma was drained and healed by second intention. Devices were activated 3 months after implantation. At a mean 2.5 years follow-up, the 3 patients had an activated and functional artificial sphincter. Leaks and fecal urgency significantly decreased but colonic enemas were maintained. Dietary restrictions were less and quality of life improved. All 3 considered the device as a useful adjunct.
  
  
  CONCLUSIONS
  In this limited experience, implantation of artificial sphincter around a perineal colostomy following APR for rectal cancer appeared feasible and safe even in case of previous radiotherapy. Mid-term tolerance was satisfactory. Continence and quality of life significantly improved.
authors.affiliation: Clinique chirurgicale II, Pôle digestif, Hôtel Dieu, Nantes, France.
authors.forename: Frédéric
authors.initials: F
authors.lastname: Marchal
authors.forename: Carole
authors.initials: C
authors.lastname: Doucet
authors.forename: David
authors.initials: D
authors.lastname: Lechaux
authors.forename: Philippe
authors.initials: P
authors.lastname: Lasser
authors.forename: Paul-Antoine
authors.initials: PA
authors.lastname: Lehur
mesh_terms: D000368:Aged; D001003:Anal Canal; D003125:Colostomy; D004733:Enema; D005242:Fecal Incontinence; D005260:Female; D006801:Humans; D008875:Middle Aged; D017060:Patient Satisfaction; D010502:Perineum / Q000601:surgery; D019736:Prostheses and Implants; D011788:Quality of Life; D012004:Rectal Neoplasms / Q000601:surgery*