title: Neuromodulation of perineally transposed antropylorus with pudendal nerve anastomosis following total anorectal reconstruction in humans.
abstract: BACKGROUND
  We have reported perineal antropyloric segment transposition with its pudendal innervation as a replacement for anal sphincter. Our aim herein was to neuromodulate this segment by electrical stimulation.
  
  
  METHODS
  Eight patients with a permanent colostomy underwent perineal antropyloric segment transposition followed by neural anastomosis of its anterior vagus branch to pudendal nerve branch in the perineum. Perineal antropyloric graft was assessed for its functional integrity and electrophysiological effects. Nerve stimulation was done by surface stimulation technique, using a customized stimulation protocol for smooth muscle. Antral pressures were recorded on voluntary attempts and on nerve stimulation with simultaneous concentric needle electromyography of the perineal antropylorus.
  
  
  RESULTS
  The antral segment showed slow spontaneous contractions (2-3/min) on digital examination, endoscopy, and electrophysiology. Stimulated antropyloric electromyography showed a latency of 2-5 s with a differential rise in amplitude (mean range 58.57-998.75 μV) according to the frequency of stimulation (range 10-150 Hz). An average latency of 10 s in relation to rise in the antral pressure was observed on pudendal nerve stimulation. Triggering of the intrinsic rhythm was observed in patients where it was initially absent. Voluntary attempts at contraction also showed a rise in perineally transposed antral pressure.
  
  
  CONCLUSIONS
  Spontaneous rhythm, its generation after electrical stimulation, and response to voluntary contraction demonstrates the viability and functional reinnervation of the perineally transposed antropyloric segment. Rise in pressure on electrical stimulation shows evidence for its neuromodulation.
authors: Department of Surgical Gastroenterology, King George's Medical University, Lucknow, India.
authors: Abhijit
authors: A
authors: Chandra
authors: Hardeep S
authors: HS
authors: Malhotra
authors: Noushif
authors: N
authors: M
authors: Vishal
authors: V
authors: Gupta
authors: Sunil K
authors: SK
authors: Singh
authors: Neeraj
authors: N
authors: Kumar
authors: Rakesh S
authors: RS
authors: Lalla
authors: Ayush
authors: A
authors: Chandra
authors: Ravindra K
authors: RK
authors: Garg
mesh_terms: D000293:Adolescent; D000328:Adult; D001003:Anal Canal / Q000294:innervation / Q000503:physiopathology* / Q000601:surgery*; D000714:Anastomosis, Surgical; D004558:Electric Stimulation; D004576:Electromyography; D005242:Fecal Incontinence / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D060525:Pudendal Nerve / Q000503:physiopathology*; D011708:Pylorus / Q000294:innervation / Q000503:physiopathology* / Q000637:transplantation*; D019651:Plastic Surgery Procedures; D055815:Young Adult
keywords: anal sphincter; neuromodulation; pudendal nerve; pylorus; smooth muscle