title: Perineal pseudocontinent colostomy for ultra-low rectal adenocarcinoma: the muscular graft as a pseudosphincter.
abstract: OBJECTIVE
  The aim of this study was to analyze objectively the role of the muscular graft in the continence using manometric study in the patients who underwent pseudocontinent perineal colostomy after abdominoperineal resection for rectal adenocarcinoma.
  
  
  METHODS
  This was a retrospective study including all the patients from January 2002 to December 2009 who underwent an abdominoperineal resection followed by perineal pseudocontinent colostomy for ultra-low rectal adenocarcinoma and agreed to perform the manometric evaluation of the muscular graft.
  
  
  RESULTS
  Fifteen patients were included, six males and nine females, with a mean age of 50 years. According to Kirwan's classification, 2 (13.3%) patients had normal continence (Stage A) had 10 (66.6%) no soiling (stage B) and 3 (20%) patients had minimal soiling (Stage C). The manometric evaluation was performed after a median period of 12 months post-surgery. The mean maximal resting and squeeze pressures were respectively 41 cmH2O and 59 cmH2O and the mean colonic sensory volume was 12 ml.
  
  
  CONCLUSIONS
  This study showed that the musculae graft of Pseudocontinent Perineal colostomy acted as a hypotonic sphincter that pressure can increase during the voluntary squeeze. These data may help to clarify the functional outcomes of this technique after APR for ultra-low rectal adenocarcinoma.
authors.affiliation: a Surgical Department, Medical School, National Institute of Oncology , University Mohammed Vth Souissi, Rabat , Rabat , Morocco.
authors.forename: Amine
authors.initials: A
authors.lastname: Souadka
authors.affiliation: b Department of General Surgery, Medical School , University Mohammed Vth Souissi, Rabat , Rabat , Morocco.
authors.forename: Mohammed Anass
authors.initials: MA
authors.lastname: Majbar
authors.affiliation: c Gastroenterology Unit, Medical School, National Institute of Oncology , University Mohammed Vth Souissi, Rabat , Rabat , Morocco.
authors.forename: Laila
authors.initials: L
authors.lastname: Amrani
authors.affiliation: a Surgical Department, Medical School, National Institute of Oncology , University Mohammed Vth Souissi, Rabat , Rabat , Morocco.
authors.forename: Abdelilah
authors.initials: A
authors.lastname: Souadka
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D001003:Anal Canal / Q000502:physiology; D015331:Cohort Studies; D003125:Colostomy / Q000379:methods*; D005242:Fecal Incontinence / Q000517:prevention & control; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008365:Manometry; D008875:Middle Aged; D064827:Myocutaneous Flap / Q000706:statistics & numerical data*; D010502:Perineum / Q000601:surgery*; D011788:Quality of Life; D012004:Rectal Neoplasms / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D018570:Risk Assessment; D016378:Tissue Transplantation / Q000379:methods; D016896:Treatment Outcome
keywords: Rectal adenocarcinoma; abdominoperineal resection; functional results; manometric evaluation; pseudocontinent perineal colostomy